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Open Access 01-12-2023 | Craniotomy | Research

Association between preoperative serum sodium and postoperative 30-day mortality in adult patients with tumor craniotomy

Authors: Yufei Liu, Haofei Hu, Zongyang Li, Yuandi Yang, Fanfan Chen, Weiping Li, Liwei Zhang, Guodong Huang

Published in: BMC Neurology | Issue 1/2023

Abstract

Background

Limited data exist regarding preoperative serum sodium (Na) and 30-day mortality in adult patients with tumor craniotomy. Therefore, this study investigates their relationship.

Methods

A secondary retrospective analysis was performed using data from the ACS NSQIP database (2012–2015). The principal exposure was preoperative Na. The outcome measure was 30-day postoperative mortality. Binary logistic regression modeling was conducted to explore the link between them, and a generalized additive model and smooth curve fitting were applied to evaluate the potential association and its explicit curve shape. We also conducted sensitivity analyses and subgroup analyses.

Results

A total of 17,844 patients (47.59% male) were included in our analysis. The mean preoperative Na was 138.63 ± 3.23 mmol/L. The 30-day mortality was 2.54% (455/17,844). After adjusting for covariates, we found that preoperative Na was negative associated with 30-day mortality. (OR = 0.967, 95% CI:0.941, 0.994). For patients with Na ≤ 140, each increase Na was related to a 7.1% decreased 30-day mortality (OR = 0.929, 95% CI:0.898, 0.961); for cases with Na > 140, each increased Na unit was related to a 8.8% increase 30-day mortality (OR = 1.088, 95% CI:1.019, 1.162). The sensitivity analysis and subgroup analysis indicated that the results were robust.

Conclusions

This study shows a positive and nonlinear association between preoperative Na and postoperative 30-day mortality in adult patients with tumor craniotomy. Appropriate preoperative Na management and maintenance of serum Na near the inflection point (140) may reduce 30-day mortality.

Lonjaret L, Guyonnet M, Berard E, Vironneau M, Peres F, Sacrista S, et al. Fourcade and T. Geeraerts: postoperative complications after craniotomy for brain tumor surgery. Anaesth Crit Care Pain Med. 2017;36(4):213–8. https://doi.org/10.1016/j.accpm.2016.06.012.CrossRefPubMed

Noordzij PG, Poldermans D, Schouten O, Bax JJ, Schreiner FA, Boersma E. Postoperative mortality in the Netherlands: a population-based analysis of surgery-specific risk in adults. Anesthesiology. 2010;112(5):1105–15. https://doi.org/10.1097/ALN.0b013e3181d5f95c.CrossRefPubMed

Senders JT, Muskens IS, Cote DJ, Goldhaber NH, Dawood HY, Gormley WB, et al. Thirty-day outcomes after craniotomy for primary malignant brain tumors: a National Surgical Quality Improvement Program Analysis. Neurosurgery. 2018;83(6):1249–59. https://doi.org/10.1093/neuros/nyy001.CrossRefPubMed

Watters DA, Hollands MJ, Gruen RL, Maoate K, Perndt H, McDougall RJ, et al. Perioperative mortality rate (POMR): a global indicator of access to safe surgery and anaesthesia. World J Surg. 2015;39(4):856–64. https://doi.org/10.1007/s00268-014-2638-4.CrossRefPubMed

Hankinson TC, Dudley RW, Torok MR, Patibandla MR, Dorris K, Poonia S, et al. Short-term mortality following surgical procedures for the diagnosis of pediatric brain tumors: outcome analysis in 5533 children from SEER, 2004–2011. J Neurosurg Pediatr. 2016;17(3):289–97. https://doi.org/10.3171/2015.7.PEDS15224.CrossRefPubMed

Williams M, Treasure P, Greenberg D, Brodbelt A, Collins P. Surgeon volume and 30 day mortality for brain tumours in England. Br J Cancer. 2016;115(11):1379–82. https://doi.org/10.1038/bjc.2016.317.CrossRefPubMedPubMedCentral

Dmitrieva NI, Liu D, Wu CO, Boehm M. Middle age serum sodium levels in the upper part of normal range and risk of heart failure. Eur Heart J. 2022. https://doi.org/10.1093/eurheartj/ehac138.CrossRefPubMedPubMedCentral

Alukal JJ, John S, Thuluvath PJ. Hyponatremia in cirrhosis: an update. Am J Gastroenterol. 2020;115(11):1775–85. https://doi.org/10.14309/ajg.0000000000000786.CrossRefPubMed

Khan FW, Fatima B, Lahr BD, Greason KL, Schaff HV, Dearani JA, et al. Hyponatremia: an overlooked risk factor Associated with adverse outcomes after cardiac surgery. Ann Thorac Surg. 2021;112(1):91–8. https://doi.org/10.1016/j.athoracsur.2020.08.030.CrossRefPubMed

10.

Sakr Y, Rother S, Ferreira AM, Ewald C, Dunisch P, Riedemmann N, et al. Fluctuations in serum sodium level are associated with an increased risk of death in surgical ICU patients. Crit Care Med. 2013;41(1):133–42. https://doi.org/10.1097/CCM.0b013e318265f576.CrossRefPubMed

11.

Ebrahim M, Larsen PB, Hannani D, Liest S, Jorgensen LN, Jorgensen HL. Preoperative risk factors including serum levels of potassium, sodium, and creatinine for early mortality after open abdominal surgery: a retrospective cohort study. BMC Surg. 2021;21(1):62. https://doi.org/10.1186/s12893-021-01070-0.CrossRefPubMedPubMedCentral

12.

Leise MD, Yun BC, Larson JJ, Benson JT, Yang JD, Therneau TM, et al. Effect of the pretransplant serum sodium concentration on outcomes following liver transplantation. Liver Transpl. 2014;20(6):687–97. https://doi.org/10.1002/lt.23860.CrossRefPubMedPubMedCentral

13.

Williams CN, Riva-Cambrin J, Presson AP, Bratton SL. Hyponatremia and poor cognitive outcome following pediatric brain tumor surgery. J Neurosurg Pediatr. 2015;15(5):480–7. https://doi.org/10.3171/2014.10.PEDS14368.CrossRefPubMed

14.

Feinstein AJ, Davis J, Gonzalez L, Blackwell KE, Abemayor E, Mendelsohn AH. Hyponatremia and perioperative complications in patients with head and neck squamous cell carcinoma. Head Neck. 2016;38(Suppl 1):E1370–4. https://doi.org/10.1002/hed.24229.CrossRefPubMed

15.

Wang Q, Peng L, Han Y, Li T, Dai W, Wang Y, et al. Preoperative serum Sodium Level as a prognostic and predictive biomarker for adjuvant therapy in Esophageal Cancer. Front Oncol. 2020;10:555714. https://doi.org/10.3389/fonc.2020.555714.CrossRefPubMed

16.

Li W, Chen X, Wang L, Wang Y, Huang C, Wang G, et al. The prognostic effects of hyponatremia and hyperchloremia on postoperative NSCLC patients. Curr Probl Cancer. 2019;43(5):402–10. https://doi.org/10.1016/j.currproblcancer.2018.12.006.CrossRefPubMed

17.

Xu J, Chen X, Wang X, Zhu C, Hu Y, Yang X, et al. Preoperative hyponatremia and Hypocalcemia Predict Poor Prognosis in Elderly Gastric Cancer Patients. Cancer Manag Res. 2019;11:8765–80. https://doi.org/10.2147/CMAR.S211603.CrossRefPubMedPubMedCentral

18.

Martin JY, Goff BA, Urban RR. Preoperative hyponatremia in women with ovarian cancer: an additional cause for concern? Gynecol Oncol. 2016;142(3):471–6. https://doi.org/10.1016/j.ygyno.2016.06.018.CrossRefPubMedPubMedCentral

19.

Yeh HC, Li CC, Wen SC, Singla N, Woldu SL, Robyak H, et al. Validation of Hyponatremia as a prognostic predictor in Multiregional Upper Tract Urothelial Carcinoma. J Clin Med. 2020;9(4). https://doi.org/10.3390/jcm9041218.

20.

Sterns RH. Disorders of plasma sodium–causes, consequences, and correction. N Engl J Med. 2015;372(1):55–65. https://doi.org/10.1056/NEJMra1404489.CrossRefPubMed

21.

Castle-Kirszbaum M, Kyi M, Wright C, Goldschlager T, Danks RA, Parkin WG. Hyponatraemia and hypernatraemia: Disorders of Water Balance in Neurosurgery. Neurosurg Rev. 2021;44(5):2433–58. https://doi.org/10.1007/s10143-020-01450-9.CrossRefPubMed

22.

Hasegawa H, Shin M, Makita N, Shinya Y, Kondo K, Saito N. Delayed postoperative hyponatremia following endoscopic transsphenoidal surgery for non-adenomatous parasellar tumors. Cancers (Basel). 2020;12(12). https://doi.org/10.3390/cancers12123849.

23.

Voglis S, van Niftrik C, Staartjes VE, Brandi G, Tschopp O, Regli L, et al. Feasibility of machine learning based predictive modelling of postoperative hyponatremia after pituitary surgery. Pituitary. 2020;23(5):543–51. https://doi.org/10.1007/s11102-020-01056-w.CrossRefPubMed

24.

Rahman M, Friedman WA. Hyponatremia in neurosurgical patients: clinical guidelines development. Neurosurgery. 2009;65(5). https://doi.org/10.1227/01.NEU.0000358954.62182.B3. 925 – 35; discussion 935-6.

25.

Leung AA, McAlister FA, Rogers SJ, Pazo V, Wright A, Bates DW. Preoperative hyponatremia and perioperative complications. Arch Intern Med. 2012;172(19):1474–81. https://doi.org/10.1001/archinternmed.2012.3992.CrossRefPubMed

26.

Pennington Z, Bomberger TT, Lubelski D, Benzel EC, Steinmetz MP, Mroz TE. Preoperative hyponatremia and perioperative complications in cervical spinal Fusion. World Neurosurg. 2020;141:e864–72. https://doi.org/10.1016/j.wneu.2020.06.068.CrossRefPubMed

27.

Crestanello JA, Phillips G, Firstenberg MS, Sai-Sudhakar C, Sirak J, Higgins R, et al. Preoperative hyponatremia predicts outcomes after cardiac surgery. J Surg Res. 2013;181(1):60–6. https://doi.org/10.1016/j.jss.2012.06.004.CrossRefPubMed

28.

Ramburuth M, Moodley Y, Gopalan PD. Preoperative serum sodium measurements and postoperative inpatient mortality: a case-control analysis of data from the South African Surgical Outcomes Study. S Afr Med J. 2018;108(10):847–51. https://doi.org/10.7196/SAMJ.2018.v108i10.13178.CrossRefPubMed

29.

Zhang J, Li YI, Pieters TA, Towner J, Li KZ, Al-Dhahir MA, et al. Sepsis and septic shock after craniotomy: Predicting a significant patient safety and quality outcome measure. PLoS ONE. 2020;15(9). https://doi.org/10.1371/journal.pone.0235273. e0235273.

30.

Vandenbroucke JP, von Elm E, Altman DG, Gotzsche PC, Mulrow CD, Pocock SJ. Schlesselman and M. Egger: strengthening the reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. PLoS Med. 2007;4(10). https://doi.org/10.1371/journal.pmed.0040297. e297.

31.

Mullee A, Romaguera D, Pearson-Stuttard J, Viallon V, Stepien M, Freisling H, et al. Association between soft drink consumption and mortality in 10 european countries. JAMA Intern Med. 2019;179(11):1479–90. https://doi.org/10.1001/jamainternmed.2019.2478.CrossRefPubMed

32.

Keidel D, Anto JM, Basagana X, Bono R, Burte E, Carsin AE, et al. The role of Socioeconomic Status in the association of lung function and Air Pollution-A Pooled Analysis of three adult ESCAPE cohorts. Int J Environ Res Public Health. 2019;16(11). https://doi.org/10.3390/ijerph16111901.

33.

Haneuse S, VanderWeele TJ, Arterburn D. Using the E-Value to assess the potential effect of unmeasured confounding in Observational Studies. JAMA. 2019;321(6):602–3. https://doi.org/10.1001/jama.2018.21554.CrossRefPubMed

34.

Liu Y, Hu H, Li Z, Yang J, Zhang X, Chen L, et al. Association between preoperative platelet and 30-day postoperative mortality of adult patients undergoing craniotomy for brain tumors: data from the American College of Surgeons National Surgical Quality Improvement Program database. BMC Neurol. 2022;22(1):465. https://doi.org/10.1186/s12883-022-03005-5.CrossRefPubMedPubMedCentral

35.

Muhlestein WE, Akagi DS, Davies JM, Chambless LB. Predicting Inpatient length of stay after brain tumor surgery: developing machine learning ensembles to improve predictive performance. Neurosurgery. 2019;85(3):384–93. https://doi.org/10.1093/neuros/nyy343.CrossRefPubMed

36.

Sorba EL, Staartjes VE, Voglis S, Tosic L, Brandi G, Tschopp O, et al. Diabetes insipidus and syndrome of inappropriate antidiuresis (SIADH) after pituitary surgery: incidence and risk factors. Neurosurg Rev. 2021;44(3):1503–11. https://doi.org/10.1007/s10143-020-01340-0.CrossRefPubMed

37.

Kitchlu A, Rosner MH. Hyponatremia in patients with cancer. Curr Opin Nephrol Hypertens. 2019;28(5):433–40. https://doi.org/10.1097/MNH.0000000000000525.CrossRefPubMed

38.

Seo MS, Hwang IC, Jung J, Lee H, Choi JH, Shim JY. Hypernatremia at admission predicts poor survival in patients with terminal cancer: a retrospective cohort study. BMC Palliat Care. 2020;19(1):94. https://doi.org/10.1186/s12904-020-00607-z.CrossRefPubMedPubMedCentral

Title: Association between preoperative serum sodium and postoperative 30-day mortality in adult patients with tumor craniotomy
Authors: Yufei Liu
Haofei Hu
Zongyang Li
Yuandi Yang
Fanfan Chen
Weiping Li
Liwei Zhang
Guodong Huang
Publication date: 01-12-2023
Publisher: BioMed Central
Keywords: Craniotomy
Brain Tumor
Hypernatremia
Hyponatremia
Published in: BMC Neurology / Issue 1/2023
Electronic ISSN: 1471-2377
DOI: https://doi.org/10.1186/s12883-023-03412-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Association between preoperative serum sodium and postoperative 30-day mortality in adult patients with tumor craniotomy

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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