Early postoperative hypoalbuminemia is a risk factor for postoperative acute kidney injury following hip fracture surgery |
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| Affiliation: | 1. Harvard Combined Orthopaedic Residency Program, Boston, MA, USA;2. Beth Israel Deaconess Medical Center, Boston, MA, USA;1. Department of Orthopedic Surgery, The Third Affiliated Hospital, Southern Medical University, Guangzhou, Guangdong, 510630, China;2. Department of Orthopedic Surgery, The First Traditional Chinese Medical Hospital of Hunan Changde, Changde, Hunan, 415000, China;3. Department of Biomedical Sciences, West Virginia School of Osteopathic Medicine, Lewisburg, WV, 24901, United States;4. Department of Pharmacology, School of Pharmacy, Southwest Medical University, Luzhou, Sichuan, 646000, China;1. Experimental Surgery and Regenerative Medicine (ExperiMed), Department of General, Trauma and Reconstructive Surgery, Munich University Hospital, Ludwig-Maximilians-University (LMU), Nussbaumstr. 20, 80336 Munich, Germany;2. Paracelsus Medical University (PMU) Salzburg, Strubergasse 21, 5020 Salzburg, Austria;1. Department of Surgery, Brooke Army Medical Center, JBSA Fort Sam Houston, TX;2. Prolonged Field Care, U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, TX;3. Department of Surgery, Uniformed Services University, Bethesda, MD |
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| Abstract: | IntroductionAcute kidney injury (AKI) is a common and serious complication after hip fracture surgery in older adults. Hypoalbuminemia is a known independent risk factor for AKI. However, few studies have investigated the relationship between early postoperative hypoalbuminemia and AKI after hip fracture surgery. Therefore, we sought to determine the incidence of and risk factors for AKI and the effects of early postoperative hypoalbuminemia on AKI incidence after surgery for hip fractures, especially intertrochanteric fractures of the proximal femur.Patients and methodsIn this retrospective cohort study from a single center, we reviewed the medical records of 481 consecutive patients (>60 years) who underwent surgery for intertrochanteric fracture of the proximal femur. Multiple logistic regression was performed to identify independent risk factors for AKI. After determining the cut-off value of the minimal level of postoperative serum albumin during the first two postoperative days, we divided the patients into two groups: group 1 included 251 patients whose minimal early postoperative serum albumin level was <2.9 g/dL during the first two postoperative days; and group 2 included 230 patients whose minimal early postoperative serum albumin level was ≥2.9 g/dL. The incidence of AKI was analyzed using inverse probability of treatment weighting (IPTW), propensity score matching (PSM), and propensity score matching weighting (PSMW) analyses.ResultsThe incidence of AKI, defined based on the Kidney Disease Improving Global Outcomes criteria, was 11.8% (n = 57). Chronic kidney disease and the minimal early postoperative serum albumin level <2.9 g/dL at any point during the first two postoperative days were independent risk factors for AKI. The IPTW, PSM, and PSMW analyses comparing the incidence of AKI between the two groups revealed that the minimal early postoperative serum albumin level <2.9 g/dL was significantly associated with AKI development (P < 0.001, P = 0.025, and P = 0.011, respectively).ConclusionThe incidence of postoperative AKI was 11.8%. Our findings demonstrate that early postoperative hypoalbuminemia is an independent risk factor for AKI in patients undergoing surgery for intertrochanteric fracture of the proximal femur. |
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| Keywords: | Hip fracture Surgery Postoperative acute kidney injury Hypoalbuminemia |
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