Does Preoperative Antiviral Treatment for Hepatitis C Decrease Risk of Complications After Total Hip Arthroplasty? A Matched Cohort Study

Ross, Austin J.; Ross, Bailey J.; Lee, Olivia; Hood, Hunter W.; Sanchez, Fernando L.; Sherman, William F.

doi:10.1016/j.arth.2022.02.102

Cited by 6 publications

(3 citation statements)

References 45 publications

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“…Patients with hepatitis C virus (HCV) appear to be at risk of serious complications after elective orthopaedic surgery, so an increasing amount of research has sought to reduce that risk using preoperative treatment with interferon or direct-acting antivirals. Sustained negative viral load is linked to minimizing postoperative mechanical complications, particularly periprosthetic joint infection [4, 12]. The authors of an article in this month’s Clinical Orthopaedics and Related Research ® [2] earlier published a multicenter study finding that patients treated with antiviral therapy before arthroplasty were less likely to experience periprosthetic joint infection at 90 days and 1 year after surgery [3].…”

Section: Where Are We Now?mentioning

confidence: 99%

CORR Insights®: Child-Pugh Class B or C Liver Disease Increases the Risk of Early Mortality in Patients With Hepatitis C Undergoing Elective Total Joint Arthroplasty Regardless of Treatment Status

Wera

2023

Clin Orthop Relat Res

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Section: Where Are We Now?mentioning

confidence: 99%

CORR Insights®: Child-Pugh Class B or C Liver Disease Increases the Risk of Early Mortality in Patients With Hepatitis C Undergoing Elective Total Joint Arthroplasty Regardless of Treatment Status

Wera

2023

Clin Orthop Relat Res

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“…That study generated heterogeneity and the findings cannot be generalized to patients undergoing elective TJA. Orthopaedic studies recently conducted on patients with HCV undergoing elective TJA have focused either on early postoperative outcomes including in-hospital complications and readmissions for mechanical or infectious etiologies in matched case-control studies [23] or the outcomes of treating HCV with antiviral medications to achieve a negative viral load compared with untreated patients, with limited emphasis on early mortality and its risk factors [8,25]. Other investigations have used large-registry databases either on the state or national level to assess the impact of HCV on early postoperative complication risks within 90 days and 1 year of surgery, with a specific emphasis on reoperation for PJI, which is the most morbid complication sustained postoperatively [12,15,27].…”

Section: Introductionmentioning

confidence: 99%

“…Great empahsis has been placed on treating these patients for HCV before elective total joint arthroplasty (TJA), irrespective of therapy modality, to minimize medical and surgical complications, including periprosthetic joint infection (PJI) [4]. Further research has confirmed the necessity of achieving a sustained negative viral load with treatment before TJA to mitigate the extended length of stay and greater mechanical complications and PJI in these patients than in those with a detectable viral load [7,8,20], as well as to achieve a similar risk of complications at 2 years postoperatively to controls without HCV [25,26]. Achieving a sustained virologic response in nonsurgical patients with HCV has correlated well with a long-term decrease in allcause mortality, liver-related mortality, and nonliver-related mortality, especially in patients with a history of decompensated liver cirrhosis [21].…”

Section: Introductionmentioning

confidence: 99%

Child-Pugh Class B or C Liver Disease Increases the Risk of Early Mortality in Patients With Hepatitis C Undergoing Elective Total Joint Arthroplasty Regardless of Treatment Status

Cichos

Jordan

Niknam

et al. 2023

Clin Orthop Relat Res

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Background Patients with hepatitis C virus (HCV) undergoing primary elective total joint arthroplasty (TJA) are at increased risk of postoperative complications. Patients with chronic liver disease and cirrhosis, specifically Child-Pugh Class B and C, who are undergoing general surgery have high 2-year mortality risks, approaching 60% to 80%. However, the role of Child-Pugh and Model for End-Stage Liver Disease classifications of liver status in predicting survivorship among patients with HCV undergoing elective arthroplasty has not been elucidated. Question/purpose What factors are independently associated with early mortality (< 2 years) in patients with HCV undergoing arthroplasty? Methods We performed a retrospective study at three tertiary academic medical centers and identified patients with HCV undergoing primary elective TJA between January 2005 and December 2019. Patients who underwent revision TJA and simultaneous primary TJA were excluded. A total of 226 patients were eligible for inclusion in the study. A further 25% (57) were excluded because they were lost to follow-up before the minimum study requirement of 2 years of follow-up or had incomplete datasets. After the inclusion and exclusion criteria were applied, the final cohort consisted of 75% (169 of 226) of the initial patient population eligible for analysis. The mean follow-up duration was 53 ± 29 months. We compared confounding variables for mortality between patients with early mortality (16 patients) and surviving patients (153 patients), including comorbidities, HCV and liver characteristics, HCV treatment, and postoperative medical and surgical complications. Patients with early postoperative mortality were more likely to have an associated advanced Child-Pugh classification and comorbidities including peripheral vascular disease, end-stage renal disease, heart failure, and chronic obstructive pulmonary disease. However, both groups had similar 90-day and 1-year medical complication risks including myocardial infarction, stroke, pulmonary embolism, and reoperations for periprosthetic joint infection and mechanical failure. A multivariable regression analysis was performed to identify independent factors associated with early mortality, incorporating all significant variables with p < 0.05 present in the univariate analysis. Results After accounting for significant variables in the univariate analysis such as peripheral vascular disease, end-stage renal disease, heart failure, chronic obstructive pulmonary disease, and liver fibrosis staging, Child-Pugh Class B or C classification was found to be the sole factor independently associated with increased odds of early (within 2 years) mortality in patients with HCV undergoing elective TJA (adjusted odds ratio 29 [95% confidence interval 5 to 174]; p < 0.001). The risk of early mortality in patients with Child-Pugh Class B or C was 64% (seven of 11) compared with 6% (nine of 158) in patients with Child-Pugh Class A (p < 0.001). Conclusion Patients with HCV and a Child-Pugh Class B or C at the time of elective TJA had substantially increased odds of death, regardless of liver function, cirrhosis, age, Model for End-Stage Liver Disease level, HCV treatment, and viral load status. This is similar to the risk of early mortality observed in patients with chronic liver disease undergoing abdominal and cardiac surgery. Surgeons should avoid these major elective procedures in patients with Child-Pugh Class B or C whenever possible. For patients who feel their arthritic symptoms and pain are unbearable, surgeons need to be clear that the risk of death is considerably elevated. Level of Evidence Level III, therapeutic study.

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Antiviral Treatment for Hepatitis C Is Associated With a Reduced Risk of Periprosthetic Joint Infection: A Meta-Analysis of Observational Studies

Cheng

Yan

et al. 2022

The Journal of Arthroplasty

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Does Preoperative Antiviral Treatment for Hepatitis C Decrease Risk of Complications After Total Hip Arthroplasty? A Matched Cohort Study

Cited by 6 publications

References 45 publications

CORR Insights®: Child-Pugh Class B or C Liver Disease Increases the Risk of Early Mortality in Patients With Hepatitis C Undergoing Elective Total Joint Arthroplasty Regardless of Treatment Status

CORR Insights®: Child-Pugh Class B or C Liver Disease Increases the Risk of Early Mortality in Patients With Hepatitis C Undergoing Elective Total Joint Arthroplasty Regardless of Treatment Status

Child-Pugh Class B or C Liver Disease Increases the Risk of Early Mortality in Patients With Hepatitis C Undergoing Elective Total Joint Arthroplasty Regardless of Treatment Status

Antiviral Treatment for Hepatitis C Is Associated With a Reduced Risk of Periprosthetic Joint Infection: A Meta-Analysis of Observational Studies

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