title: An analysis of renal dysfunction in 1511 patients with fractured neck of femur: the implications for peri-operative analgesia.
abstract: Following two deaths from respiratory failure secondary to opioid toxicity in patients admitted for surgical repair of fractured neck of femur, we retrospectively studied the serum urea and electrolyte concentrations of 1511 consecutive patients requiring surgery for proximal femoral fracture, and calculated their glomerular filtration rate. Five hundred and forty-five (36.1%) patients had renal dysfunction on admission (glomerular filtration rate < 60 ml x min(-1).1.73 m(-2)); 435 (28.8%) had grade 3 chronic kidney disease (moderate; glomerular filtration rate 30-59 ml x min(-1).1.73 m(-2)), 82 (5.4%) had grade 4 disease (severe; glomerular filtration rate 15-29 ml x min(-1).1.73 m(-2)) and 28 (1.9%) had grade 5 (renal failure; glomerular filtration rate < 15 ml min(-1).1.73 m(-2)). The 30-day mortality for patients with renal dysfunction (62/536; 11.6%) was significantly greater (p = 0.004) than for patients with normal renal function (68/958; 7.1%), although median (IQR [range]) postoperative lengths of stay were similar 15 (10-22 [1-125]) vs 14 (9-22 [1-120]) days respectively; p = 0.06). Renal impairment is common in patients admitted for fixation of fractured neck of femur, who are consequently at risk of opioid toxicity.
authors.affiliation: Royal Sussex County Hospital, Brighton, East Sussex, UK. igasbest@hotmail.com
authors.forename: S M
authors.initials: SM
authors.lastname: White
authors.forename: N
authors.initials: N
authors.lastname: Rashid
authors.forename: A
authors.initials: A
authors.lastname: Chakladar
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000698:Analgesia / Q000379:methods*; D000701:Analgesics, Opioid; D019643:Arthroplasty, Replacement / Q000379:methods; D000075202:Contraindications; D004812:Epidemiologic Methods; D005260:Female; D005265:Femoral Neck Fractures / Q000150:complications* / Q000601:surgery; D005593:Fracture Fixation, Internal / Q000379:methods; D005919:Glomerular Filtration Rate; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000517:prevention & control; D019990:Perioperative Care / Q000379:methods; D051437:Renal Insufficiency / Q000150:complications* / Q000503:physiopathology
chemical_list: D000701:Analgesics, Opioid