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Ng M, Carrieri PM, Awendila L, Socías ME, Knight R, Ti L. Hepatitis C Virus Infection and Hospital-Related Outcomes: A Systematic Review. Can J Gastroenterol Hepatol 2024; 2024:3325609. [PMID: 38487594 PMCID: PMC10940031 DOI: 10.1155/2024/3325609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 10/24/2023] [Accepted: 02/12/2024] [Indexed: 03/17/2024] Open
Abstract
Background People living with hepatitis C infection (HCV) have a significant impact on the global healthcare system, with high rates of inpatient service use. Direct-acting antivirals (DAAs) have the potential to alleviate this burden; however, the evidence on the impact of HCV infection and hospital outcomes is undetermined. This systematic review aims to assess this research gap, including how DAAs may modify the relationship between HCV infection and hospital-related outcomes. Methods We searched five databases up to August 2022 to identify relevant studies evaluating the impact of HCV infection on hospital-related outcomes. We created an electronic database of potentially eligible articles, removed duplicates, and then independently screened titles, abstracts, and full-text articles. Results A total of 57 studies were included. Analysis of the included studies found an association between HCV infection and increased number of hospitalizations, length of stay, and readmissions. There was less consistent evidence of a relationship between HCV and in-hospital mortality. Only four studies examined the impact of DAAs, which showed that DAAs were associated with a reduction in hospitalizations and mortality. In the 14 studies available among people living with HIV, HCV coinfection similarly increased hospitalization, but there was less evidence for the other hospital-related outcomes. Conclusions There is good to high-quality evidence that HCV negatively impacts hospital-related outcomes, primarily through increased hospitalizations, length of stay, and readmissions. Given the paucity of studies on the effect of DAAs on hospital outcomes, future research is needed to understand their impact on hospital-related outcomes.
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Affiliation(s)
- Michelle Ng
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, British Columbia, Canada V6Z 2A9
| | - Patrizia Maria Carrieri
- Faculté de Médecine, Aix Marseille Université, 27 bd Jean Moulin 13385, Marseille Cedex 5, France
| | - Lindila Awendila
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard St, Vancouver, British Columbia, Canada V6Z 1Y6
| | - Maria Eugenia Socías
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, British Columbia, Canada V6Z 2A9
- Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, British Columbia, Canada V5Z 1M9
| | - Rod Knight
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, British Columbia, Canada V6Z 2A9
- École de Santé Publique de l'Université de Montréal, 7101 Avenue du Parc, Montréal, Québec, Canada H3N 1X9
| | - Lianping Ti
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, British Columbia, Canada V6Z 2A9
- Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, British Columbia, Canada V5Z 1M9
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Cheng T, Li G, Mao X, Hao L, Cheng X, Ning H. Impact of Hepatitis B virus infection on postoperative complications and length of stay in elderly patients with hip fracture: A retrospective cohort study. Injury 2023:S0020-1383(23)00453-9. [PMID: 37198044 DOI: 10.1016/j.injury.2023.05.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 03/28/2023] [Accepted: 05/10/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Osteoporosis and subsequent fractures are common in the chronic hepatitis B (CHB) population, especially in the elderly. This study investigated the effects of hepatitis B virus (HBV) infection on postoperative outcomes following hip fracture surgery. METHODS The study identified elderly patients who underwent hip fracture surgery at three academic tertiary care centres between January 2014 and December 2020. Propensity score matching was performed to compare the outcomes of 1,046 patients with HBV infection to 1,046 controls. RESULTS The seroprevalence of HBV among elderly patients undergoing hip surgery was 4.94%. The HBV cohort had significantly higher rates of medical complications (28.1 vs. 22.7%, p = 0.005), surgical complications (14.0 vs. 9.7%, p = 0.003), and unplanned readmissions (18.9 vs. 14.5%, p = 0.03) within 90 days of surgery. Patients with HBV infection were more likely to have increased length of stay (6.2 vs. 5.9 days, p = 0.009) and in-hospital charges (¥52,231 vs. ¥49,832, p < 0.00001). Multivariate logistic regression suggested that liver fibrosis and thrombocytopenia were independent risk factors for major complications and extended LOS. CONCLUSION Patients with HBV infection were at greater risk of adverse postoperative outcomes. We should pay more attention to the considerable burden of perioperative management of CHB patients. Due to the high proportion of undiagnosed patients in the Chinese elderly population, universal HBV screening should be considered preoperatively.
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Affiliation(s)
- Tao Cheng
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, The People's Republic of China.
| | - Guoyong Li
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, The People's Republic of China
| | - Xin Mao
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, The People's Republic of China
| | - Liang Hao
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, The People's Republic of China.
| | - Xigao Cheng
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, The People's Republic of China
| | - Huiming Ning
- Department of Infectious Disease, Shanghai Eighth People's Hospital, Shanghai, The People's Republic of China
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Wier JR, Firoozabadi R, Patterson JT. Cirrhosis is independently associated with complications and mortality following operative treatment of acetabular fractures. Injury 2023; 54:S0020-1383(23)00171-7. [PMID: 36878732 DOI: 10.1016/j.injury.2023.02.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 02/19/2023] [Indexed: 03/08/2023]
Abstract
INTRODUCTION Patients with cirrhosis are at higher risk for morbidity after injury. Acetabular fractures represent a highly morbid injury pattern. Few studies have specifically examined an effect of cirrhosis on risk of complications after acetabular fracture. We hypothesized that cirrhosis is independently associated with increased risk of inpatient complications following operative treatment of acetabular fractures. METHODS Adults patients with acetabular fracture who underwent operative treatment were identified from Trauma Quality Improvement Program data from 2015 to 2019. Patients with and without cirrhosis were matched on a propensity score predicting cirrhotic status and inpatient complications based on patient, injury, and treatment characteristics. The primary outcome was overall complication rate. Secondary outcomes included serious adverse event rate, overall infection rate, and mortality. RESULTS After propensity score matching, 137 cirrhosis+ and 274 cirrhosis- remained. No significant differences existed in observed characteristics after matching. Compared to cirrhosis- patients, cirrhosis+ patients experienced 43.4% (83.9 vs 40.5%, p < 0.001) greater absolute risk difference of any inpatient complication, 29.9% (51.8 vs 21.9%, p < 0.001) greater absolute risk difference of serious adverse events, 28.5% (41.6 vs 13.1%, p < 0.001) greater absolute risk difference of any infection, and 2.9% (2.9% vs 0.0%, p = 0.02) greater absolute risk difference of inpatient mortality. CONCLUSION Cirrhosis is associated with higher rates of inpatient complications, serious adverse events, infection, and mortality among patients undergoing operative repair of acetabular fracture. LEVEL OF EVIDENCE Prognostic Level III.
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Affiliation(s)
- Julian R Wier
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Reza Firoozabadi
- Department of Orthopedics and Sports Medicine, University of Washington, Seattle, WA, USA
| | - Joseph T Patterson
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
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4
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Ross AJ, Ross BJ, Lee OC, Williams GH, Savoie FH, O’Brien MJ, Sanchez FL, Sherman WF. Does Pre-Arthroplasty Antiviral Treatment for Hepatitis C Reduce Complication Rates After Total Shoulder Arthroplasty? A Matched Cohort Study. JSES Int 2022; 6:910-916. [PMID: 36353415 PMCID: PMC9637694 DOI: 10.1016/j.jseint.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
Abstract
Background Hepatitis C virus (HCV) is associated with increased complications of risk after arthroplasty. The purpose of this study was to examine the impact of HCV and a pre-arthroplasty antiviral treatment on complications following total shoulder arthroplasty (TSA). Methods A retrospective matched cohort study was conducted using an administrative claims database. Patients who underwent TSA were identified with Current Procedural Terminology -23472 and International Classification of Diseases procedural codes. A total of 1244 HCV patients were matched 1:3 with 3732 noninfected controls across age, sex, diabetes mellitus, tobacco use, and obesity. The HCV patients with treatment before TSA were identified by claims containing antiviral drug codes. Multivariable logistic regression was used to compare rates of 90-day medical complications and prosthesis-related complications within 2 years postoperatively for (1) HCV patients vs. controls, (2) antiviral-treated HCV patients vs. controls, and (3) antiviral-treated HCV patients vs. untreated HCV patients. Results Patients with HCV exhibited significantly higher rates of blood transfusion (OR 2.12), acute kidney injuries (OR 1.86), inpatient readmission (OR 2.06), revision TSA (OR 1.48), dislocation (OR 1.92), mechanical complications (OR 1.39), and prosthetic joint infection (OR 1.53) compared to controls. Antiviral-treated HCV patients exhibited a significantly lower rate of myocardial infarction (OR 0.27) and comparable rates of all other complications relative to controls (all P > .05). Compared to untreated HCV patients, antiviral-treated HCV patients exhibited significantly lower rates of 90-day medical complications (OR 0.57) and prosthetic joint infection (OR 0.36). Conclusions HCV is associated with significantly increased complication rates after TSA. Antiviral treatment before TSA may reduce the risk of postoperative complications.
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Szapary HJ, Monárrez R, Varady NH, Hanna P, Chen AF, Rodriguez EK. Complications and predictors of morbidity for hip fracture surgery in patients with chronic liver disease. Hip Int 2022:11207000221112923. [PMID: 35836328 DOI: 10.1177/11207000221112923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Despite the fact that patients with chronic liver disease (CLD) are at increased risk of complications after a fracture of the hip, there remains little information about the risk factors for acute postoperative complications and their overall outcome.The aim of this study was to describe inpatient postoperative complications and identify predictors of postoperative morbidity. METHODS Patients with CLD who had been treated for a fracture of the hip between April 2005 and August 2019 were identified from a retrospective search of an intramural trauma registry based in the Northeastern United States. Medical records were reviewed for baseline demographics, preoperative laboratory investigations, and outcomes. RESULTS The trauma registry contained 110 patients with CLD who had undergone surgery for a fracture of the hip. Of these, patients with a platelet-count of ⩽100,000/µL were 3.81 (95% CI, 1.59-9.12) times more likely to receive a transfusion than those with a platelet-count of >100,000/µL. Those with a Model for End-stage Liver Disease (MELD) score of >9 were 5.54 (2.33-13.16) times more likely to receive a transfusion and 3.97 (1.06-14.81) times more likely to develop postoperative delirium than those with a MELD score of ⩽9.Of patients without chronic kidney disease, those with a creatinine of ⩾1.2 mg/dL were 6.80 (1.79-25.87) times more likely to develop acute renal failure (ARF) than those with a creatinine of <1.2 mg/dL. In a multivariable model, as MELD score was increased, the odds of developing a composite postoperative complication, which included transfusion, ARF, delirium, or deep wound infection, were 1.29 (1.01-1.66). Other tools used to assess surgical risks, Charlson Comorbidity Index, Elixhauser, and American Society of Anesthesiologist scores, were not predictive. CONCLUSIONS Patients with CLD who undergo surgery for a hip fracture have a high rate of postoperative complications which can be predicted by the preoperative laboratory investigations identified in this study and MELD scores, but not by other common comorbidity indices.
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Affiliation(s)
- Hannah J Szapary
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Rubén Monárrez
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.,Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Rubin Institute for Advanced Orthopedics, Sinai Hospital, Baltimore, MD, USA
| | - Nathan H Varady
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Philip Hanna
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Antonia F Chen
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Edward K Rodriguez
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Ross AJ, Ross BJ, Lee OC, Hood HW, Sanchez FL, Sherman WF. Does Preoperative Antiviral Treatment for Hepatitis C Decrease Risk of Complications After Total Hip Arthroplasty? A Matched Cohort Study. J Arthroplasty 2022; 37:1326-1332.e3. [PMID: 35248753 DOI: 10.1016/j.arth.2022.02.102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/28/2022] [Accepted: 02/23/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) is associated with increased complication risk after elective arthroplasty. The purpose of this study is to examine the impact of HCV and prearthroplasty antiviral treatment on complications following total hip arthroplasty (THA). METHODS A retrospective matched cohort study was conducted using an administrative claims database. In total, 6,883 HCV patients were matched 1:3 with 20,694 noninfected controls, and 920 HCV patients with antiviral treatment before THA (treated HCV) were matched 1:4 with 3,820 HCV patients without treatment (untreated HCV). Rates of 90-day medical complications and joint complications within 2 years postoperatively were compared with multivariable logistic regression. RESULTS HCV patients exhibited significantly increased rates of medical complications within 90 days compared to noninfected controls (all P < .01). At 2 years postoperatively, HCV patients also exhibited significantly higher risk of revision THA (odds ratio [OR] 1.81), dislocation (OR 2.06), mechanical complications (OR 1.40), periprosthetic fracture (OR 1.76), and prosthetic joint infection (PJI) (OR 1.79). However, treated HCV patients exhibited statistically comparable risk of all joint complications at 2 years postoperatively relative to controls (all P > .05). Compared to untreated HCV patients, treated HCV patients exhibited significantly lower risk of inpatient readmission within 90 days (OR 0.58) and PJI at 2 years postoperatively (OR 0.62). CONCLUSION HCV patients exhibit significantly increased risk of medical and joint complications following THA relative to controls, though prearthroplasty antiviral treatment mitigates complication risk. Treated HCV patients exhibited significantly lower risk of inpatient readmission and PJI compared to untreated HCV patients. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Austin J Ross
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Bailey J Ross
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Olivia C Lee
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana; Department of Orthopaedic Surgery & Southeast Louisiana Veterans Health Care System, Louisiana State University School of Medicine, New Orleans, Louisiana
| | - Hunter W Hood
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Fernando L Sanchez
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - William F Sherman
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana
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7
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A Missed Opportunity: The Impact of Hepatitis C Treatment Prior to Total Knee Arthroplasty on Postoperative Complications. J Arthroplasty 2022; 37:709-713.e2. [PMID: 34954018 DOI: 10.1016/j.arth.2021.12.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/26/2021] [Accepted: 12/15/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Hepatitis C (HCV) is undertreated and increasing in prevalence. Its influence on outcomes following total knee arthroplasty (TKA) remains unclear. The purpose of this study is to examine the impact of HCV and prearthroplasty antiviral treatment on postoperative complications following TKA. METHODS A retrospective matched cohort study was conducted using an administrative claims database to compare postoperative complication rates following TKA for (1) patients with vs without HCV and (2) among patients with HCV, patients with antiviral treatment before TKA vs no treatment. In total, 6971 patients with HCV were matched 1:4 with 27,884 controls without HCV, and 708 HCV patients with antiviral treatment before TKA were matched 1:2 with 1416 HCV patients without treatment. Rates of joint complications at 1 and 2 years postoperatively were compared via multivariable logistic regression. RESULTS The HCV cohort exhibited significantly higher risk of prosthetic joint infection (PJI) than controls at both 1 (4.1 vs 2.1%; odds ratio [OR] 1.58) and 2 years (5.0% vs 2.7%; OR 1.55) postoperatively. Rates of revision TKA were also significantly higher for HCV patients at 1 (2.8% vs 1.8%; OR 1.40) and 2 years (4.1% vs 2.9%; OR 1.30). HCV patients with prearthroplasty antiviral treatment exhibited significantly lower risk of PJI at 1 (2.1% vs 4.1%; OR 0.50) and 2 years (2.7% vs 5.1%, OR 0.51) compared to patients without treatment. CONCLUSION Patients with HCV have significantly increased risk of PJI and revision arthroplasty following TKA. Antiviral treatment before TKA significantly decreases the risk of PJI postoperatively. LEVEL OF EVIDENCE Level III.
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8
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9
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Tseng FJ, Gou GH, Wang SH, Shyu JF, Pan RY. Chronic liver disease and cirrhosis increase morbidity in geriatric patients treated surgically for hip fractures: analysis of the US Nationwide Inpatient Sample. BMC Geriatr 2022; 22:150. [PMID: 35197007 PMCID: PMC8867787 DOI: 10.1186/s12877-022-02832-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 02/09/2022] [Indexed: 11/21/2022] Open
Abstract
Background This study aimed to evaluate the impact of chronic liver disease and cirrhosis on inpatient outcomes of geriatric hip fracture surgery. Materials and methods Using population-based retrospective study design, this study extracted data from the US Nationwide Inpatient Sample (NIS) database 2005–2014, identifying patients aged ≥ 65 years undergoing hip fracture repair. Main outcomes were in-hospital mortality, any/specific complications, non-routine discharge, extended length of stay (LOS) and hospital costs. Associations between cirrhosis, non-cirrhotic chronic liver disease and outcomes were determined using regression analysis. Results Data of 347,363 hip fracture patients included 344,035 without liver disease, 1257 with non-cirrhotic chronic liver disease and 2,071 with cirrhosis. After adjustments, non-cirrhotic chronic liver disease was significantly associated with non-routine discharge (OR: 1.247, 95% CI: 1.038–1.498), acute kidney injury (OR: 1.266, 95% CI: 1.039–1.541), extended LOS (OR: 1.285, 95% CI: 1.122–1.473) and hospital costs (beta: 9173.42, 95% CI: 6925.9–11,420.95) compared to no liver disease; while cirrhosis was significantly associated with higher risk of in-hospital mortality (OR: 2.325, 95% CI: 1.849–2.922), any complication (OR: 1.295, 95% CI: 1.143–1.467), acute kidney injury (OR: 1.242, 95% CI: 1.177–1.433), non-routine discharge (OR: 1.650, 95% CI: 1.412–1.928), extended LOS (OR: 1.405, 95% CI: 1.263–1.562) and hospital costs (beta: 6680.24, 95% CI: 4921.53–8438.95) compared to no liver disease. Conclusion In geriatric hip fracture patients undergoing surgical repair, non-cirrhotic chronic liver disease and cirrhosis independently predict non-routine discharge, acute kidney injury, prolonged LOS and greater hospital costs, and cirrhosis is also significantly associated with greater risk of any complication and in-hospital mortality. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02832-y.
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Affiliation(s)
- Feng-Jen Tseng
- Department of Orthopedics, Hualien Armed Forces General Hospital, Hualien, 971, Taiwan, ROC.,Department of Life Science and the Institute of Biotechnology, National Dong Hwa University, Hualien, 974, Taiwan, ROC.,Department of Orthopaedics, Tri-Service General Hospital, National Defense Medical Center, Taipei, 11490, Taiwan, ROC
| | - Guo-Hau Gou
- Graduate Institute of Medical Sciences, National Defense Medical Center, No. 161, Section 6, Mingchuan E. Road, Neihu District 114, Taipei, 11490, Taiwan, ROC
| | - Sheng-Hao Wang
- Graduate Institute of Medical Sciences, National Defense Medical Center, No. 161, Section 6, Mingchuan E. Road, Neihu District 114, Taipei, 11490, Taiwan, ROC.,Department of Orthopaedics, Tri-Service General Hospital, National Defense Medical Center, Taipei, 11490, Taiwan, ROC
| | - Jia-Fwu Shyu
- Department of Biology and Anatomy, National Defense Medical Center, Taipei, 11490, Taiwan, ROC
| | - Ru-Yu Pan
- Graduate Institute of Medical Sciences, National Defense Medical Center, No. 161, Section 6, Mingchuan E. Road, Neihu District 114, Taipei, 11490, Taiwan, ROC. .,Department of Orthopaedics, Tri-Service General Hospital, National Defense Medical Center, Taipei, 11490, Taiwan, ROC.
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10
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Fang C, Cornell E, Dicken Q, Freccero D, Mattingly D, Smith EL. Coinfection of HIV and hepatitis C increases complication rates after total joint arthroplasty. SICOT J 2020; 6:37. [PMID: 32960168 PMCID: PMC7507831 DOI: 10.1051/sicotj/2020035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 08/30/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION As advances in efficacy of human immunodeficiency virus (HIV) and hepatitis-C virus (HCV) anti-viral medications increase, patients are able to maintain higher quality of lives than ever before. While these patients live longer lives, the unique patient population of those co-infected with both HIV and HCV increases. As these older patients seek orthopaedic care, it is important to understand their unique outcome profile. The purpose of this study was to evaluate the complication rate after total joint arthroplasty (TJA) in patients with HIV and HCV coinfection compared with patients with HIV or HCV only. METHODS A retrospective review of patients undergoing primary total joint arthroplasty (TJA) at our urban, academic hospital between April 2016 and April 2019 was conducted. Patients were stratified into three groups according to viral status: HIV only, HCV only, or HIV and HCV coinfection. Baseline demographics, intravenous drug (IV) use, surgery type, CD4+ count, follow-up and complications were analysed. RESULTS Of the 133 patients included in the study, 28 had HIV, 88 had HCV and 17 were coinfected with both HIV and HCV. Coinfected patients were more likely to have a lower BMI (p < 0.039) and a history of IV drug use (p < 0.018) compared to patients with either HIV or HCV only. Coinfected patients had a higher complication rate (41%) than both HIV only (7%; p < 0.001) and HCV only (12.5%; p < 0.001) patients. DISCUSSION Patients coinfected with HIV and HCV undergoing TJA have a higher complication rate than patients with either infection alone. As this unique population of coinfected patients continues to expand, increasingly they will be under the care of arthroplasty surgeons. Improved awareness and understanding of the baseline demographic differences between these patients is paramount. Recognition of the increased complication rates grants the opportunity to improve their orthopaedic care through preoperative and multidisciplinary management.
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Affiliation(s)
- Christopher Fang
- New England Baptist Hospital, 125 Parker Hill Ave, Boston, 02120 MA, USA
| | - Ella Cornell
- Boston Medical Center, One Boston Medical Center Pl, Boston, 02118 MA, USA
| | - Quinten Dicken
- Boston Medical Center, One Boston Medical Center Pl, Boston, 02118 MA, USA
| | - David Freccero
- Boston Medical Center, One Boston Medical Center Pl, Boston, 02118 MA, USA
| | - David Mattingly
- New England Baptist Hospital, 125 Parker Hill Ave, Boston, 02120 MA, USA
| | - Eric L Smith
- New England Baptist Hospital, 125 Parker Hill Ave, Boston, 02120 MA, USA
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11
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Zhao K, Zhang J, Li J, Meng H, Wang Z, Zhu Y, Hou Z, Zhang Y. Incidence and risk factors of surgical site infection after intertrochanteric fracture surgery: A prospective cohort study. Int Wound J 2020; 17:1871-1880. [PMID: 32840067 DOI: 10.1111/iwj.13477] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/22/2020] [Accepted: 07/22/2020] [Indexed: 12/26/2022] Open
Abstract
Surgical site infection (SSI) is a challenging complication after intertrochanteric fracture surgery but without a large-sample size study to investigate the incidence and risk factors of it. The present study was to investigate the incidence and risk factors of SSI after intertrochanteric fracture surgery. A total of 1941 patients underwent intertrochanteric fracture surgery between October 2014 and December 2018 were included. Demographic data, surgical variables, and preoperative laboratory indexes were obtained from a prospective database and reviewed by hospital records. The optimum cut-off value for quantitative data was detected by receiver operating characteristic analysis. The univariate analysis and multivariable analysis were conducted to analyse the risk factors. In total, 25 patients (1.3%) developed SSI, including 22(1.1%) superficial infection and 3(0.2%) deep infection. After adjustment of multiple variables, gender (odds ratio[OR] 2.64, P = .024), time to surgery>4 days (OR 2.41, P = .046), implant (intramedullary or extramedullary devices) (OR 2.96, P = .036), ALB<35 g/L (OR 2.88, P = .031) remained significant factors. In conclusion, the incidence of SSI after intertrochanteric fractures surgery was 1.3%, with 1.1% for superficial and 0.2% for deep infection. Gender, time to surgery>4 days, the implant (intramedullary or extramedullary devices), and ALB<35 g/L were independent risk factors for the rate of SSI.
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Affiliation(s)
- Kuo Zhao
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Junzhe Zhang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Junyong Li
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hongyu Meng
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhongzheng Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yanbin Zhu
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yingze Zhang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
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12
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Hepatitis C Virus Infection as a Predictor of Complications and Increased Costs Following Primary Lumbar Fusion Surgery. Spine (Phila Pa 1976) 2020; 45:E1020-E1025. [PMID: 32706565 DOI: 10.1097/brs.0000000000003481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE The aim of this study was to identify whether hepatitis C virus (HCV) diagnosis influences in-hospital lengths of stay (LOS), postoperative complications, readmission rates, or costs following primary posterior lumbar fusions in an elective setting. SUMMARY OF BACKGROUND DATA Although joint arthroplasty literature has shown increased complication rates and costs for patients seropositive with HCV without liver disease compared to those without HCV, this comorbidity has not been explored in the spine literature. To our knowledge, this is the first publication in the lumbar spine literature to solely focus on HCV as the disease burden. METHODS A national database was queried for patients who underwent primary lumbar spine fusion for degenerative lumbar pathology with Medicare insurance from 2005 to 2014. The 90-day postoperative complication rates, readmission rates, and treatment costs were queried. To limit confounding, HCV patients were matched with a control cohort of non-HCV patients using patient demographics, treatment modality, and comorbid conditions, and then analyzed by multivariate logistic regression. Patients with active liver disease were excluded to better isolate HCV as the comorbidity. RESULTS A cohort of 28,841 patients were included in the final analysis. Postoperatively, compared to those without HCV infection, those with HCV had significantly higher odds of blood transfusions (odds ratio [OR]: 3.06), pneumonia (OR: 2.49), respiratory failure (OR: 2.49), urinary tract infections (OR: 1.89), wound-/implant-related infections (OR: 1.74), cerebrovascular events (OR: 1.70), or any postoperative complication within 90 days (OR: 2.93; all P < 0.0001). Furthermore, HCV positive patients had higher day of surgery costs ($28,713.26 vs. $25,448.26, P < 0.0001) and 90-day costs ($33,447.39 vs. $29,016.77, P < 0.0001). There was not a significant difference for patients with HCV infection compared to those without in regard to hospital LOS (10 days vs. 8 days, P = 0.332) and rates of a 90-day readmission (0.37% vs. 0.22%; OR: 1.70, 95% confidence interval: 1.00-2.90, P: 0.050). CONCLUSION In patients undergoing primary lumbar fusion, a seropositivity for HCV without liver disease is associated with higher costs and complication rates, including higher rates of blood transfusion requirements and pneumonia-related complications. This data shed new light on elective spine surgery in HCV patients and may influence the risks and benefits considerations for surgeons considering lumbar fusion in this population. LEVEL OF EVIDENCE 3.
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