Background and Aims Post-operative hyponatremia is a relatively common occurrence. We identified risk factors (see table 1) for the development of hyponatremia and developed a risk calculator (http://orthoapps.shinyapps.io/Hponatremia_TJA/ ) (Kunze, 2022). In a prospective study, a best practice alert (BPA) was sent to the practitioner advising them to use plasma-lyte instead of lactated rangers along with other precautions for patients having 3 of the 4 pre- op risk factors.
Methods We examined joint replacement patients at the Hospital for Special Surgery from March 2022 to March 2023. Prescribers received best practice alerts (BPA) when patients were determined to be at risk for hyponatremia. Descriptive statistical analyses were performed.
Results Between March 2022 and March 2023, the hospital’s overall hyponatremia rate dropped from 29% to 14% (p<0.05). Moderate hyponatremia dropped from 3.4% in March 2022 to 1.3% in March 2023. During the same period, severe hyponatremia dropped from 0.57% to 0.22%. The instituted BPA was sent 16,357 times across 1,078 patients at risk for hyponatremia. 31% of these patients developed mild hyponatremia (Na = 130-134) and 10% developed moderate (Na < 130). Plasma-lyte usage is on the rise throughout hospitals and will soon become the standard IV fluid solution for surgical patients.
Conclusions A best practice alert helped identify patients at risk for hyponatremia, resulting in a reduction of postoperative hyponatremia. Additionally, concurrent plasma-lyte administration decreased the incidence and severity of hyponatremia. Pre-operative detection of postoperative hyponatremia may improve if the hyponatremia risk calculator includes post-operative risk factors such blood loss and surgery duration.
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