Increased Complication Rates After Hip and Knee Arthroplasty in Patients With Cirrhosis of the Liver

Abstract

Background Risk stratification is critical in patients with cirrhosis undergoing THAs and TKAs, as they may be more likely to have serious medical and surgical complications. As opposed to the Child-Pugh scoring system, which has limited use for orthopaedic surgeons inexperienced in assessing ascites and hepatic encephalopathy, the Model for End-stage Liver Disease (MELD) is an easily calculated, validated scoring system for severity of liver disease based on common laboratory values; however, its usefulness for predicting complications after elective arthroplasty has not been studied. Questions/purposes The purposes of this study were to determine the differences between patients with cirrhosis and control subjects in (1) hospital length of stay, discharge disposition, and readmission within 90 days; (2) early postoperative (90 days) medical complications potentially related to liver disease; (3) surgical complications within 90 days and any time after the procedure; (4) mortality rates after THA and TKA; and in addition, (5) to use the MELD score as a predictor for risk of complications and mortality. Methods Institutional database query software used coding data identified 115 patients with liver cirrhosis before having THAs or TKAs from 2000 to 2012 and 115 control subjects without cirrhosis matched by age, sex, procedure, and year of surgery. Early postoperative and longer-term medical and surgical complications were compared. Regression analysis was used to determine a MELD score that predicted greater risk of complications. Results Compared with matched control subjects, patients with cirrhosis had prolonged length of stay and higher rates of discharge to nursing facilities, readmission in 90 days, and urinary tract infections (p \ 0.01), renal failure (p = 0.03), blood transfusions (p \ 0.01), gastrointestinal hemorrhage (p = 0.04), dislocations (p = 0.01), infections (p = 0.02), and revisions (p = 0.04) within 90 days.One-year (p = 0.01) and longer-term (p = 0.0002) mortality rates were greater in patients with cirrhosis. A MELD score of 10 or greater predicted a three times increased likelihood (odds ratio [OR]) of any complication (95% CI, 1.28-7.00; p = 0.01) and 4.1 times Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research. Informed consent was deemed unnecessary by our institutional review board.

In‐Hospital mortality varies by procedure type among cirrhosis surgery admissions

“…Several smaller studies have shown that within the context of a given surgical procedure, post‐operative mortality increases with worsening severity of liver disease . These data separately corroborate our general findings of high short‐term mortality associated with major abdominal and cardiovascular surgery, and lower short‐term mortality with orthopedic procedures and cholecystectomy . However, prior to this study, no large‐scale studies have directly compared mortality risk among different surgical procedures .…”

Impact of Cirrhosis on Resource Use and Inpatient Complications in Patients Undergoing Total Knee and Hip Arthroplasty

“…The cirrhosis patients also had significantly increased LOS, readmission, reoperation, mortality and costs. Similarly, Tiberi et al[14] performed a smaller study using data from a single institution and found patients with cirrhosis had significantly more blood transfusions, renal failure, infections, dislocations, revision surgery and mortality. Pneumonia was more common in patients with cirrhosis in the setting of THA.…”

Successful Treatment of Total Hip Arthroplasty to a Patient Associated with Alcoholic Cirrhosis and Severe Plated Deficiency with Preoperative Partial Splenic Embolization

“…They mentioned a 5-year survival rate in patient with cirrhosis after THA was 77.8% [2]. Tiberi et al described within 90 days of the procedure, patient with cirrhosis had greater number of hip dislocation, infection and revision surgeries and appropriate patient counseling is advised if THA is needed [3].…”