Prosthetic hip infection in patients with liver cirrhosis: an outcome analysis

Hsieh, Pang‐Hsin; Ueng, Steve Wen–Neng; Lee, Mel S.; Shih, Hsin-Nung; Huang, Kuo‐Chin

doi:10.1016/j.ijid.2010.06.018

Cited by 14 publications

(13 citation statements)

References 25 publications

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“…The prolonged length of stay is in accordance with previous reports [7,9]; however, to our knowledge, there is no published study that has evaluated disposition requirements or readmission rates. Our findings likely are related to the underlying morbidity of these patients and the increased early postoperative medical and surgical complications.…”

Section: Discussionsupporting

confidence: 90%

“…Our transfusion data were contrary to those reported by Shih et al [15] (no difference between patients with cirrhosis and control subjects after TKA) and Cohen et al [7] (increased transfusion requirement for emergent THA but not elective THA in patients with cirrhosis versus control subjects). Rates of urinary tract infection (range, 2%-5%) [9,15], acute renal failure (5%) [9], and gastrointestinal hemorrhage (range, 2%-5%) [9,15] have been reported in contrast to our 12% rate; however, these studies did not directly compare these rates with those of the control subjects.…”

Section: Discussioncontrasting

confidence: 69%

“…This may indicate that patients with cirrhosis have a greater early postoperative surgical risk but not a longerterm one. Hsieh et al [9] reported a 22.2% infection rate and 22.2% 5-year failure rate in patients with cirrhosis after THA. Shih et al [15] reported five early and one late infection and one revision after 51 TKAs in patients with cirrhosis.…”

Section: Discussionmentioning

confidence: 99%

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

Tiberi

Hansen

El-Abbadi

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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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.

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Section: Discussionsupporting

confidence: 90%

Section: Discussioncontrasting

confidence: 69%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

Tiberi

Hansen

El-Abbadi

et al. 2014

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

show abstract

“…Additionally, we could assess only end points that resulted in hospital admission. Although it is likely that nearly all patients with periprosthetic joint infections who present during the first 6 months would be treated on an inpatient basis [10], we are unable to identify patients who were treated conservatively as outpatients. Additionally, we could not assess certain outcomes such as overall mortality after hospital discharge as these data were not available.…”

Section: Discussionmentioning

confidence: 99%

“…Current literature evaluating the results of TJA in patients with cirrhosis has been limited to small case series with groups of less than 100 patients [4,10,19,20,26]. In general these studies agreed that patients with cirrhosis had higher rates of periprosthetic joint infections, but given the small number of patients, there was limited evaluation of risk factors.…”

Section: Introductionmentioning

confidence: 99%