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Association between postoperative changes in natremia and outcomes in patients undergoing elective craniotomy

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Abstract

Postoperative dysnatremias, characterized by imbalances in serum sodium levels, have been linked to increased resource utilization and mortality in surgical and intensive care patients. The management of dysnatremias may involve medical interventions based on changes in sodium levels. In this study, we aimed to investigate the impact of postoperative changes in natremia on outcomes specifically in patients undergoing craniotomy.

We conducted a retrospective analysis of patient records from the Department of Neurosurgery at West China Hospital, Sichuan University, covering the period from January 2011 to March 2021. We compared the highest and lowest sodium values in the first 14 postoperative days with the baseline values to define four categories for analysis: no change < 5 mmol/L; decrease > 5 mmol/L; increase > 5 mmol/L; both increase and decrease > 5 mmol/L. The primary outcome measure was 30-day mortality.

A total of 12,713 patients were included in the study, and the overall postoperative mortality rate at 30 days was 2.1% (264 patients). The increase in sodium levels carried a particularly high risk, with a tenfold increase (OR 10.21; 95% CI 7.25–14.39) compared to patients with minimal or no change. Decreases in sodium levels were associated with an increase in mortality (OR 1.60; 95% CI 1.11–2.23).

Moreover, the study revealed that postoperative sodium decrease was correlated with various complications, such as deep venous thrombosis, pneumonia, intracranial infection, urinary infection, seizures, myocardial infarction, and prolonged hospital length of stay. On the other hand, postoperative sodium increases were associated with acute kidney injury, deep venous thrombosis, pneumonia, intracranial infection, urinary infection, surgical site infection, seizures, myocardial infarction, and prolonged hospital length of stay.

Changes in postoperative sodium levels were associated with increased complications, prolonged length of hospital stay, and 30-day mortality. Moreover, the severity of sodium change values correlated with higher mortality rates.

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Data availability

The data of this study is available from the corresponding author on reasonable request.

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Funding

This work is supported by National Natural Science Foundation of China(82271364), the innovation team project of Affiliated Hospital of Clinical Medicine College of Chengdu University (CDFYCX202203), and the project of Sichuan Science and Technology Bureau (22ZDYF0798), the 1·3·5 project for disciplines of excellence-Clinical Research Incubation Project, West China Hospital, Sichuan University (21HXFH046), Chengdu Municipal Health Commission (No. 2023375)，the project of health commission of Sichuan province (2019HR50), Nursing Association of Sichuan Province H21003, and Science and Technology Research Project of Chongqing Municipal Education Commission.

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Authors and Affiliations

  1. Department of Neurosurgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China

    Tiangui Li, Xin Cheng, Yixing Tian, Jialing He, Yangchun Xiao, Chao You & Fang Fang

  2. Department of Neurosurgery, The First People’s Hospital of Longquanyi District Chengdu, Sichuan, China

    Tiangui Li

  3. Center for Evidence-Based Medical, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China

    Yu Zhang & Pengfei Hao

  4. Department of Neurosurgery, Shanxi Provincial People’s Hospital, Taiyuan, Shanxi, China

    Lu Jia

  5. Department of Anesthesia, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China

    Miao He

  6. Department of Critical Care Medicine, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China

    Lvlin Chen & Liyuan Peng

  7. Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, USA

    Weelic Chong

  8. Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA

    Yang Hai

Authors
  1. Tiangui Li
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  2. Yu Zhang
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  3. Xin Cheng
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  4. Lu Jia
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  5. Yixing Tian
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  8. Lvlin Chen
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  9. Pengfei Hao
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  10. Yangchun Xiao
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  11. Liyuan Peng
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  12. Weelic Chong
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  13. Yang Hai
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  15. Fang Fang
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Contributions

All authors contributed to the study conception and design. Study concept: FF. Design: All authors. Acquisition, analysis, or interpretation of data: TL and YZ. Statistical analysis: TL and YZ. Drafting of the manuscript: TL and YZ. Critical revision of the manuscript for important intellectual content: All authors.

Corresponding author

Correspondence to Fang Fang.

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Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of West China Hospital (No. 2022–705).

Consent to participate

Written informed consent from the patients was waived because this was a retrospective study.

Competing interests

The authors declare no competing interests.

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Li, T., Zhang, Y., Cheng, X. et al. Association between postoperative changes in natremia and outcomes in patients undergoing elective craniotomy. Neurosurg Rev 47, 69 (2024). https://doi.org/10.1007/s10143-024-02287-2

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  • DOI: https://doi.org/10.1007/s10143-024-02287-2

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