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

Abstract

Background Cirrhosis is a major cause of morbidity and mortality and is an important risk factor for complications in surgical patients. The purpose of this study was to investigate the association of cirrhosis with postoperative complications, length of stay (LOS), and costs among patients who underwent total knee (TKA) or hip (THA) arthroplasty. Methods Using the Nationwide Inpatient Sample between 2000 and 2011, we identified patients who had a primary TKA or primary THA. TKA patients were divided into two groups: 1) cirrhosis (n= 41,464) and 2) no cirrhosis (n= 5,721,297) and THA patients were divided into two groups: 1) cirrhosis (n= 27,401) and 2) no cirrhosis (n= 2,622,539). Patient demographics, comorbidities, perioperative complications, LOS, incremental costs were analyzed. An additional subgroup analysis by cirrhosis etiology was performed. Results Multivariable analysis revealed cirrhosis was associated with 1.55 (95%CI: 1.47–1.63) times higher odds of any complication after TKA, and 1.59 (1.50–1.69) higher odds after THA. Adjusted outcomes showed cirrhotic TKA patients had $1,857 higher costs and 0.30 days longer LOS, and THA cirrhotic patients had $1,497 higher costs and 0.48 longer LOS. We found similar results for each cirrhosis subtype, but alcohol-related had the highest resource use and complication rate. Conclusion Patients with cirrhosis who are undergoing TKA or THA are at a significantly increased risk for perioperative complications, increased LOS and higher costs. The perioperative complications and costs were highest among patients with alcohol-related cirrhosis.

The Impact of Medical Comorbidities on Primary Total Knee Arthroplasty Reimbursements

“…Newman et al demonstrated that patients with cirrhosis undergoing TKA had a mean of $1,857 higher costs and 0.30-day longer length of stay compared with noncirrhosis patients. 23 Parvizi et al also reported higher risk of mechanical complications odds ratios (ORs 4.38), increased risk of manipulation under anesthesia (OR 2.03), revision TKA for any reason (OR 4.42), and longer hospital stay (p < 0.01) in patients with hepatitis C cirrhosis who underwent a TKA in their institution. 25 Similarly, Deleuran et al used a Danish health care registry to analyze 393 cirrhosis patients compared with over 100,000 matched controls, and demonstrated that patient with cirrhosis tended to be younger, more often received general anesthesia, had more comorbidities, and were more commonly hospitalized preoperatively.…”

“…The findings of increased episode-of-care costs for patients who have comorbidities such as cirrhosis, hepatitis C, COPD, CKD, and morbid obesity directly relate to prior studies that have demonstrated greater complication rates in these patient populations. [20][21][22][23][24][25][26] The ability to limit postoperative complications has been of great interest in the arthroplasty literature as these events not only impact patients' quality of life but also increase health care expenditure drastically. 16,17,20,21 Although cost containment is critical for hospitals' long-term financial sustainability, it must not come at the expense of patient care.…”

Preoperative Care of the TKA Patient

“…Nonmodifiable risk factors include age and some chronic disease processes such as CHF, COPD, CKD, and cirrhosis. 56,58,65,66,94,[97][98][99][100][101][102][103][104][105]…”

Hematologic Malignancies Are Associated with Adverse Perioperative Outcomes following Total Knee Arthroplasty

“…Patients were sequentially excluded if they were less than 18 years old or met any of the following conditions (identified using ICD-9-CM diagnosis codes): admission type, for example; emergency, urgent, trauma center, or others; admission source of "emergency room"; pathological fractures; fractures of femur; other fractures; multiple ill-defined fractures of the lower limb; multiple fractures involving both lower limbs; acute infection of lower extremity or buttocks; diagnosis suggestive of previous arthroplasty; metastatic cancer; or fractures of the tibia and fibula. 25,26 The final study population included 5,043,210 patients who underwent TKA, of whom 5,018,496 had no hematologic malignancy and 24,714 had any hematologic malignancy. When stratified by the subtype of hematologic malignancy, the number of TKA patients in each subcategory were as follows: Hodgkin's disease (N ¼ 791), Non-Hodgkin's lymphoma (N ¼ 7,096), plasma cell dyscrasias (N ¼ 1,621), leukemia (N ¼ 8,005), myeloproliferative disease (N ¼ 5,746), and/or myelodysplastic syndromes (N ¼ 1,608).…”