Nephron · 2026
Association of Preoperative Potassium Levels with 30-Day Mortality and Other Postoperative Outcomes in Noncardiac Surgery at a Tertiary Care Center: A Retrospective Study.
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Patel Ritesh, Ansar Mariam, Talati Tirth, Bhat Vipul, Stern Matthew, Patel Pranav, Kim Sarah, Kota Nikhil, Hunter Krystal, Rachoin Jean Sebastien
Аннотация
BACKGROUND: Imbalances in serum potassium levels increase morbidity, but data on their impact on outcomes in noncardiac surgery patients remain limited.
OBJECTIVE: The aim of this surgery was to assess the association between preoperative potassium levels and postoperative outcomes in noncardiac surgery patients.
METHODS: We conducted a retrospective study of patients who underwent noncardiac surgery at Cooper Hospital between 2010 and 2022. Clinical data were obtained from the NSQIP database, while preoperative potassium values were extracted from the electronic medical records.
RESULTS: The sample consisted of 12,574 patients, comprising 39% males and 61% females. A total of 73% were white, and 18% were black. Elective procedures comprised 68.5% of cases. Preoperative potassium level was ≤3.5 mEq/L in 784 (6.2%) patients and > 5 mEq/L in 389 (3%). The hyperkalemic group was older on average and had a higher prevalence of ASA class 3 or higher. Hypokalemia was significantly associated with increased rates of postoperative mechanical ventilation (>48 h), deep vein thrombosis, sepsis, prolonged hospital stay, 30-day readmissions, and unplanned return to the operating room. Hyperkalemia was associated with higher incidences of cardiac arrhythmias, myocardial infarction, 30-day mortality, and readmissions. After multivariable regression, hypokalemia remained significantly associated with prolonged hospital length of stay and postoperative sepsis and hyperkalemia with mortality.
CONCLUSION: Preoperative potassium abnormalities assessed within 48 h of noncardiac surgery identify patients at higher postoperative risk. Hypokalemia was associated with increased ventilator use, sepsis, and prolonged hospital stay, while hyperkalemia was associated with mortality and 30-day readmission. These results support incorporating potassium status into routine perioperative evaluation while avoiding assumptions about causality. Preoperative electrolyte optimization may improve surgical outcomes and should be prioritized.
OBJECTIVE: The aim of this surgery was to assess the association between preoperative potassium levels and postoperative outcomes in noncardiac surgery patients.
METHODS: We conducted a retrospective study of patients who underwent noncardiac surgery at Cooper Hospital between 2010 and 2022. Clinical data were obtained from the NSQIP database, while preoperative potassium values were extracted from the electronic medical records.
RESULTS: The sample consisted of 12,574 patients, comprising 39% males and 61% females. A total of 73% were white, and 18% were black. Elective procedures comprised 68.5% of cases. Preoperative potassium level was ≤3.5 mEq/L in 784 (6.2%) patients and > 5 mEq/L in 389 (3%). The hyperkalemic group was older on average and had a higher prevalence of ASA class 3 or higher. Hypokalemia was significantly associated with increased rates of postoperative mechanical ventilation (>48 h), deep vein thrombosis, sepsis, prolonged hospital stay, 30-day readmissions, and unplanned return to the operating room. Hyperkalemia was associated with higher incidences of cardiac arrhythmias, myocardial infarction, 30-day mortality, and readmissions. After multivariable regression, hypokalemia remained significantly associated with prolonged hospital length of stay and postoperative sepsis and hyperkalemia with mortality.
CONCLUSION: Preoperative potassium abnormalities assessed within 48 h of noncardiac surgery identify patients at higher postoperative risk. Hypokalemia was associated with increased ventilator use, sepsis, and prolonged hospital stay, while hyperkalemia was associated with mortality and 30-day readmission. These results support incorporating potassium status into routine perioperative evaluation while avoiding assumptions about causality. Preoperative electrolyte optimization may improve surgical outcomes and should be prioritized.