Preoperative hyponatremia is associated with increased postoperative complications and s hort-to long-term mortality in geriatric hip fracture patients: a retrospective cohort study

Preoperative hyponatremia is associated with increased postoperative complications and s hort-to long-term mortality in geriatric hip fracture patients: a retrospective cohort study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Preoperative hyponatremia is associated with increased postoperative complications and s hort-to long-term mortality in geriatric hip fracture patients: a retrospective cohort study Chunhua Xi, Meixuan Wan, Haiyao Wu, Shuaihao Zhang, Yuanming He, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7607808/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 35 You are reading this latest preprint version Abstract Background Preoperative hyponatremia is a common electrolyte disorder in geriatric patients, but the adverse effects of hyponatremia on postoperative prognosis have not been fully recognized. The objective of the present study was to investigate the associations of preoperative hyponatremia with postoperative complications, short-term (before the 30th day) and long-term (before the 365th day) overall mortality for geriatric patients with hip fractures. Methods The clinical data of patients aged 60 years or older who underwent surgical treatment for hip fracture from January 2015 to December 2021 at the Seventh Medical Center, Chinese PLA General Hospital, were retrospectively analyzed, and the patients were divided into hyponatremic and normonatremic groups according to their sodium level at admission. Multivariate logistic regression and Cox proportional hazards models were used to calculate the odds ratios (ORs) for postoperative complications and the hazard ratios (HRs) for mortality. Subgroup analyses based on specific populations were performed to explore the relationship between hyponatremia and postoperative mortality. Results A total of 1901 patients were included in this study, with an incidence of preoperative hyponatremia of 12.8% (243/1440). A total of 16.5% (314/1901) of the patients experienced postoperative complications during hospitalization, 4.3% (82/1901) died within 30 days, and 14.7% (279/1901) died within 1 year. Compared with normonatremic patients, hyponatremic patients had higher odds of postoperative complications (OR = 2.34, 95% CI 1.53–3.58), and higher 30-day (HR = 2.23, 95% CI = 1.16–4.30) and 1-year (HR = 1.78, 95% CI = 1.23–2.59) mortality. Subgroup analyses revealed that the associations between hyponatremia and long-term mortality were significantly stronger in older patients and those with higher American Society of Anesthesiologists (ASA) grades (both P < 0.001). Conclusion Preoperative hyponatremia is associated with increased postoperative complications and short- to long-term mortality after hip fracture surgery in geriatric patients. Preoperative hyponatremia might be a valuable risk factor for improving the prognosis of hip fracture surgery. hip fracture hyponatremia postoperative complications mortality risk factor Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 06 Mar, 2026 Reviews received at journal 22 Feb, 2026 Reviews received at journal 20 Feb, 2026 Reviews received at journal 13 Feb, 2026 Reviews received at journal 12 Feb, 2026 Reviews received at journal 12 Feb, 2026 Reviews received at journal 10 Feb, 2026 Reviews received at journal 09 Feb, 2026 Reviewers agreed at journal 08 Feb, 2026 Reviews received at journal 08 Feb, 2026 Reviews received at journal 08 Feb, 2026 Reviews received at journal 08 Feb, 2026 Reviewers agreed at journal 06 Feb, 2026 Reviewers agreed at journal 04 Feb, 2026 Reviewers agreed at journal 03 Feb, 2026 Reviewers agreed at journal 02 Feb, 2026 Reviewers agreed at journal 01 Feb, 2026 Reviews received at journal 01 Feb, 2026 Reviewers agreed at journal 01 Feb, 2026 Reviewers agreed at journal 01 Feb, 2026 Reviewers agreed at journal 01 Feb, 2026 Reviews received at journal 01 Feb, 2026 Reviewers agreed at journal 01 Feb, 2026 Reviewers agreed at journal 31 Jan, 2026 Reviews received at journal 31 Jan, 2026 Reviewers agreed at journal 31 Jan, 2026 Reviewers agreed at journal 30 Jan, 2026 Reviewers agreed at journal 30 Jan, 2026 Reviewers agreed at journal 30 Jan, 2026 Reviewers agreed at journal 30 Jan, 2026 Reviewers agreed at journal 30 Jan, 2026 Reviewers invited by journal 08 Oct, 2025 Editor assigned by journal 23 Sep, 2025 Submission checks completed at journal 23 Sep, 2025 First submitted to journal 13 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7607808","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":531552792,"identity":"8659be60-8ac1-4aac-bd5a-31d658110138","order_by":0,"name":"Chunhua Xi","email":"","orcid":"","institution":"Capital Medical University","correspondingAuthor":false,"prefix":"","firstName":"Chunhua","middleName":"","lastName":"Xi","suffix":""},{"id":531552793,"identity":"bfbdb23c-fa76-4b49-ba8b-8a56506046f6","order_by":1,"name":"Meixuan Wan","email":"","orcid":"","institution":"Capital Medical 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study","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"hip fracture, hyponatremia, postoperative complications, mortality, risk factor","lastPublishedDoi":"10.21203/rs.3.rs-7607808/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7607808/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003ePreoperative hyponatremia is a common electrolyte disorder in geriatric patients, but the adverse effects of hyponatremia on postoperative prognosis have not been fully recognized. The objective of the present study was to investigate the associations of preoperative hyponatremia with postoperative complications, short-term (before the 30th day) and long-term (before the 365th day) overall mortality for geriatric patients with hip fractures.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThe clinical data of patients aged 60 years or older who underwent surgical treatment for hip fracture from January 2015 to December 2021 at the Seventh Medical Center, Chinese PLA General Hospital, were retrospectively analyzed, and the patients were divided into hyponatremic and normonatremic groups according to their sodium level at admission. Multivariate logistic regression and Cox proportional hazards models were used to calculate the odds ratios (ORs) for postoperative complications and the hazard ratios (HRs) for mortality. Subgroup analyses based on specific populations were performed to explore the relationship between hyponatremia and postoperative mortality.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eA total of 1901 patients were included in this study, with an incidence of preoperative hyponatremia of 12.8% (243/1440). A total of 16.5% (314/1901) of the patients experienced postoperative complications during hospitalization, 4.3% (82/1901) died within 30 days, and 14.7% (279/1901) died within 1 year. Compared with normonatremic patients, hyponatremic patients had higher odds of postoperative complications (OR\u0026thinsp;=\u0026thinsp;2.34, 95% CI 1.53\u0026ndash;3.58), and higher 30-day (HR\u0026thinsp;=\u0026thinsp;2.23, 95% CI\u0026thinsp;=\u0026thinsp;1.16\u0026ndash;4.30) and 1-year (HR\u0026thinsp;=\u0026thinsp;1.78, 95% CI\u0026thinsp;=\u0026thinsp;1.23\u0026ndash;2.59) mortality. Subgroup analyses revealed that the associations between hyponatremia and long-term mortality were significantly stronger in older patients and those with higher American Society of Anesthesiologists (ASA) grades (both \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003ePreoperative hyponatremia is associated with increased postoperative complications and short- to long-term mortality after hip fracture surgery in geriatric patients. 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