Incidental and Associated Factors Contributing to Postoperative Hyponatremia in Traumatic Brain Injury Patients Undergoing Brain Surgery at Surin Hospital
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Abstract
Background: Traumatic brain injury (TBI) is a significant health concern in Thailand, with a substantial proportion of patients requiring surgical intervention. Postoperative hyponatremia is one of the most important complications following cranial surgery, potentially leading to life-threatening conditions such as cerebral edema, impaired consciousness, seizures, prolonged hospitalization, increased demand for medical resources, and in severe cases, permanent disability or death. Early detection and timely correction of hyponatremia are crucial to prevent these adverse outcomes.
Objective: This study aimed to determine the time frame for the onset of hyponatremia following cranial surgery in patients with TBI.
Methods: A retrospective observational cohort study was conducted on patients with TBI who underwent cranial surgery at Surin Hospital from Nov 30th, 2020 to Dec 31st, 2024. A total of 361 patients were included.
Results: Hyponatremia was observed in 114 patients (31.5%). The highest incidence of hyponatremia occurred on postoperative day 7. Serum sodium levels tended to decrease progressively with each passing day after surgery, correlating with an increased occurrence of clinical symptoms related to hyponatremia over time. High-risk groups included patients aged 40–60 years (HR = 1.92, 95% CI: 1.20–3.07, p = 0.006), those with an initial Glasgow Coma Scale (GCS) score of 3–12 (HR = 2.62, 95% CI: 1.69–4.06, p < 0.001), and patients who underwent decompressive craniectomy with hematoma evacuation (HR = 3.14, 95% CI: 1.11–8.90, p = 0.031).
Conclusion: Hyponatremia commonly occurs within the first week after surgery, particularly among patients with severe traumatic brain injury who have undergone major neurosurgical procedures. Close monitoring of serum sodium levels within the first 7 days postoperatively is recommended, especially in high-risk groups, to reduce the risk of potential complications.
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References
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