Effect of Preoperative Dehydration on Postoperative Complications Following Ankle Fracture Open Reduction Internal Fixation

Abstract

Introduction

This study aims to analyze the effect of preoperative fluid status on 30-day complication, readmission, reoperation, and mortality rates following ankle fracture procedures.

Methods

The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database was queried to identify 27 175 patients undergoing open reduction and internal fixation (ORIF)of ankle fracture. Patients were stratified by hydration status (normal = 18 761, dehydrated = 8414) with preoperative dehydration, defined as a blood urea nitrogen (BUN)-to-creatinine (Cr) ratio (BUN/Cr) greater than 20.

Results

Dehydrated patients had increased rates of cardiac arrest (dehydrated = 0.2%, normal = 0.1%; P = .023), myocardial infarction (dehydrated = 0.3%, normal = 0.1%; P = .007), bleeding requiring transfusion (dehydrated = 1.3%, normal = 0.9%; P = .001), pulmonary embolism (dehydrated = 0.5%, normal = 0.3%; P = .023), and urinary tract infections (dehydrated = 1.4%, normal = 0.9%; P = .001). No significant differences in 30-day readmission or reoperation were observed between groups. Multivariable regression found hydration status was not significantly predictive of any adverse outcome, length of hospital stay (β = –0.020; 95% confidence interval [CI] = –0.132 to 0.92; P = .725), nor total operative time (β = 0.318; 95% CI = –0.968 to 1.604; P = .725).

Conclusion

This study found dehydrated patients undergoing ankle fracture ORIF experience a higher rate of complications, but this effect was not found with multivariate analysis. Thus, we conclude dehydration status was not predictive of increased risk of short-term postoperative complications, readmission, reoperation, or mortality.

Level of Evidence:

Level III, Retrospective cohort study