Impact of Cirrhosis on Morbidity and Mortality After Spinal Fusion

Abstract

Study Design: Retrospective large database study. Objective: To determine the impact of cirrhosis on perioperative outcomes and resource utilization in elective spinal fusion surgery. Methods: Elective spinal fusion hospitalizations in patients with and without cirrhosis were identified using ICD-9-CM codes between the years of 2009 and 2011 using the Nationwide Inpatient Sample database. Main outcome measures were in-hospital neurologic, respiratory, cardiac, gastrointestinal, renal and urinary, pulmonary embolism, wound-related complications, and mortality. Length of stay and inpatient costs were also collected. Multivariable logistic regressions were conducted to compare the in-hospital outcomes of patients with and without cirrhosis undergoing spinal fusion. Results: A total of 1 214 694 patients underwent elective spinal fusions from 2009 to 2011. Oh these, 6739 were cirrhotic. Cirrhosis was a significant independent predictor for respiratory (odds ratio [OR] = 1.43, confidence interval [CI] 1.29-1.58; P < .001), gastrointestinal (OR = 1.72, CI 1.48-2.00; P < .001), urinary and renal (OR = 1.90, CI 1.70-2.12; P < 0.001), wound (OR = 1.36, CI 1.17-1.58; P < 0.001), and overall inpatient postoperative complications (OR = 1.43, CI 1.33-1.53; P < .001). Cirrhosis was also independently associated with significantly greater inpatient mortality (OR = 2.32, CI 1.72-3.14; P < .001). Cirrhotic patients also had significantly longer lengths of stay (5.35 vs 3.35 days; P < .001) and inpatient costs ($36 738 vs $29 068; P < .001). Conclusions: Cirrhosis is associated with increased risk of perioperative complications, mortality and greater resource utilization. Cirrhotic patients undergoing spinal fusion surgeries should be counseled on these increased risks. Current strategies for perioperative management of cirrhotic patients undergoing spinal fusion surgery need improvement.

Recommendations from the ICM-VTE: General

“…Few studies analyzed VTE in CLD patients undergoing orthopaedic surgery. In several studies, DVT and pulmonary embolism (PE) are included in a broader category of “medical complications” and, even if these resulted as increased in CLD orthopaedic patient, it is not possible to assume a clear increased risk without extrapolated data 1406,1408-1413 .…”

Patients With Cirrhosis Have Higher Costs of Care, Longer Length of Stays, and More Perioperative Complications Following Total Knee Arthroplasty: A National Inpatient Sample-Based Study

“…It is widely recognized that cirrhotic patients tend to have poorer outcomes than the non-cirrhotic groups following major orthopedic surgeries [15][16][17]. Similarly, TKA in this sick patient population carries a distinct set of perioperative and postoperative complications [2,18,19].…”