Postoperative Dehydration Is Associated with Frailty and Decreased Survival in Older Patients with Hip Fracture.

Michela Zanetti,Paolo De Colle,Chiara Ratti,Gianluca Gortan Cappellari,Luigi Murena,Gianfranco Sanson,Rocco Barazzoni,Cinzia Omiciuolo

doi:10.3390/nu14040820

Abstract

Background: Hyperosmolar dehydration (HD) is a risk factor for severe complications in hip fracture in older patients. However, evidence for recommending screening of dehydration is insufficient and its relation with frailty and mortality is unclear. We tested the hypothesis that postoperative HD is associated with frailty and increased mortality. Methods: We recruited 625 older (>65 years) patients surgically treated for hip fracture and co-managed by an orthogeriatric team over one year in 2017. Pre- and postoperative HD (serum osmolarity > 300 mmol/L) was diagnosed. Frailty and associated mortality risk were assessed by the Multidimensional Prognostic Index (MPI). Results: The prevalence of preoperative HD was 20.4%. Compared with no-HD, MPI was similar in HD patients despite higher (p < 0.05) prevalence of polypharmacy, arterial hypertension, diabetes, chronic kidney disease and heart failure. After surgery the incidence of HD decreased to 16.5%, but increased (p = 0.003) in the MPI high-risk subgroup. Postoperative HD was associated with more complications and was an independent determinant of adjusted hospital length of stay (LOS) and of 60- to 365-days mortality. Conclusions: Older frail patients with hip fracture are prone to developing postoperative HD, which independently predicts prolonged hospital LOS and mortality. Systematically screening older patients for frailty and dehydration is advisable to customize hydration management in high-risk individuals.

Highlights

Preoperative dehydration is a well-recognized, potentially modifiable prognostic factor of in-hospital complications, hospital readmissions and of poor functional outcomes in older patients with hip fracture [1,2,3]
By ranking hip fracture patients according to frailty, it has been demonstrated that about 30% of them are frail [12] and they are predisposed to adverse clinical outcomes, including postoperative mortality, complications and prolonged length of hospital stay length of stay (LOS) [12,13]
Our findings demonstrate that all-cause mortality progressively increased over time up to 20% at one year in older hip fracture patients with postoperative hyperosmolar dehydration (HD), being significantly higher than that in patients without

Summary

Introduction

Preoperative dehydration is a well-recognized, potentially modifiable prognostic factor of in-hospital complications, hospital readmissions and of poor functional outcomes in older patients with hip fracture [1,2,3]. Several modifiable and non-modifiable risk factors influence morbidity, mortality and functional recovery after hip fracture [2,3,9,10], which include surgical variables, as well as pre-fracture patient demographics, social, functional and medical conditions. The combination of the latter factors is best described by the frailty syndrome, which is notably characterized by a decline in multiple domains and by the presence of comorbidities and polypharmacy [11]. A standardized approach based on perioperative risk evaluation and treatment optimization, as in the integrated orthogeriatric care management, is mandatory, since it results in improved short- and long-term clinical outcomes, including morbidity, LOS, functional recovery and mortality [14,15,16,17]

Objectives

Methods

Results

Discussion

Conclusion