Preoperative Dehydration Increases the Risk of Extended Length of Hospital Stay Following Total Ankle Arthroplasty

Document Type

Journal Article

Publication Date



Foot & ankle specialist




complications; dehydration; total ankle arthroplasty


INTRODUCTION: The effects of preoperative dehydration on outcomes following total ankle arthroplasty (TAA) remain unknown. Therefore, the purpose of this study is to evaluate the association between dehydration and postoperative complications for patients undergoing TAA. METHODS: Patients undergoing TAA from 2007 to 2019 were identified in the National Surgical Quality Improvement Program (NSQIP) database. A preoperative serum blood urea nitrogen/creatinine (BUN/Cr) greater than 20 was used to define preoperative dehydration. Patients were stratified into 2 cohorts: patients who were dehydrated (BUN/Cr > 20) and patients without dehydration (BUN/Cr ≤ 20). In this analysis, various postoperative outcomes were assessed with bivariate and multivariate analyses. RESULTS: In total, 1033 patients underwent TAA and had their serum BUN and Cr values recorded. For both BUN and Cr, the patients in this study had their serum values recorded a mean of 15 days before their surgery. A total of 588 patients (56.9%) did not have dehydration preoperatively and 445 patients (43.1%) were dehydrated. Following adjustment on multivariate analysis, an increased risk of extended length of hospital stay (odds ratio [OR] = 1.457; p = 0.024) was seen in the dehydrated group compared with those who were noted to be well hydrated. CONCLUSION: As fluid intake is one modifiable preoperative variable that can be easily monitored during elective procedures, it is important for physicians to be aware of patients who are dehydrated and adjust their fluids appropriately to optimize postoperative outcomes. LEVELS OF EVIDENCE: Level III: Retrospective cohort study.


Orthopaedic Surgery