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Association between dehydration on admission and postoperative complications in older persons undergoing orthopaedic surgery

AIM AND OBJECTIVES
To examine the prevalence of dehydration upon hospital admission and its association with postoperative complications in older persons undergoing orthopaedic surgery.


BACKGROUND
Ageing-related physiological and pathological changes, as well as suboptimal care quality, can render older persons vulnerable to dehydration. However, few empirical studies have been conducted to examine the association between dehydration and care outcomes in this population.


DESIGN
Retrospective documentary review.


METHODS
The medical records of patients who were aged 65 years or above and admitted for orthopaedic surgery at an acute hospital in Hong Kong over the period of January 2013 to June 2013 were reviewed. The sociodemographic characteristics, health conditions, laboratory results during index hospitalisation, postoperative care and 1-month survival were analysed. Dehydration status was defined on the basis of the ratio of blood urea nitrogen to creatinine upon admission.


RESULTS
Of 310 reviewed records, 216 records were included in the analysis. A total of 21.8% of the patients in the included cases were defined as dehydrated and 35.2% were defined as at risk of dehydration. There were significantly more patients in the dehydrated group were female, having diuretic medication, swallowing difficulty, oedema, tube feeding, diaper or urinary catheter use, with postoperative complications in respiratory, gastrointestinal and haematological systems, and died within 30 days than those in the euhydrated group.


CONCLUSIONS
The findings of this study reveal that dehydration is highly prevalent among older persons on admission. Female gender and swallowing difficulty were found to be significantly associated with dehydration, although causal inference could not be delineated through this retrospective study.


RELEVANCE TO CLINICAL PRACTICE
Given its significant influence on care outcomes and postoperative recovery, hydration care that promotes early recognition and timely management of dehydration is an integral part of fundamental care for older persons.