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Kinnard MJ, Cohen JS, Quan T, Foran JR, Sheth NP. Liver Disease Increases the Risk of Postoperative Complications in Patients Undergoing Aseptic Revision Total Hip and Knee Arthroplasty. Arthroplast Today 2024; 29:101516. [PMID: 39363937 PMCID: PMC11447298 DOI: 10.1016/j.artd.2024.101516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 07/07/2024] [Accepted: 08/09/2024] [Indexed: 10/05/2024] Open
Abstract
Background Due to the multiorgan effects of liver disease, surgical patients with liver disease have an increased risk of perioperative complications. With revision total hip and knee arthroplasty surgeries increasing, it is important to determine the effects of liver disease in this patient population. The purpose of this study was to evaluate the impact of underlying liver disease on postoperative outcomes following revision total joint arthroplasty (TJA). Methods The National Surgical Quality Improvement Program database was used to identify patients undergoing aseptic revision TJA from 2006-2019 and group them based on liver disease. The presence of liver disease was assessed by calculating the Model for End-Stage Liver Disease-Sodium score. Patients with a Model for End-Stage Liver Disease-Sodium score of > 10 were classified as having underlying liver disease. In this analysis, differences in demographics, comorbidities, and postoperative complications were assessed. Results Of 7102 patients undergoing revision total hip arthroplasty, 11.6% of the patients had liver disease. Of 8378 patients undergoing revision total knee arthroplasty, 8.4% of the patients had liver disease. Following adjustment on multivariable regression analysis, patients with liver disease undergoing revision total hip arthroplasty or revision total knee arthroplasty had an increased risk of major complications, wound complications, septic complications, bleeding requiring transfusion, extended length of stay, and readmission compared to those without liver disease. Conclusions Patients with liver disease have an increased risk of complications following revision TJA. A multidisciplinary team approach should be employed for preoperative optimization and postoperative management of these vulnerable patients to improve outcomes and decrease the incidence and severity of complications. Level of evidence This is retrospective cohort study and is level 3 evidence.
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Affiliation(s)
- Matthew J. Kinnard
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Jordan S. Cohen
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Theodore Quan
- Department of Orthopaedic Surgery, George Washington University Hospital, Washington, DC, USA
| | | | - Neil P. Sheth
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
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Elshal AM, Ghobrial FK, Laymon M, Elegeezy M, El-Nahas AR. Greenlight laser (XPS TM) 180W prostatectomy for treatment of benign prostate hyperplasia in patients with uncorrectable bleeding tendency. Arab J Urol 2022; 21:129-134. [PMID: 37234681 PMCID: PMC10208207 DOI: 10.1080/2090598x.2022.2156655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
Objectives Safety of GreenLight™ laser prostatectomy (GL-LP) in patients with ongoing blood thinners has been proven. Yet, the possibility of drug manipulation makes it a less challenging situation compared to treating patients with uncorrectable bleeding tendency. Herein, we aim at evaluating the outcomes of XPS™-180 W GL-LP for treatment of BPH in patients who had uncorrectable bleeding tendency due to hepatic dysfunction. Methods A prospectively maintained database for all patients who underwent GL-LP for symptomatic BPH was reviewed. Patients were divided into two groups based on the degree of hepatic dysfunction using Fib-4 index: Group 1 (indexed patients; low-risk Fib-4) and Group 2 (non-indexed patients; intermediate-high-risk Fib-4) included those who had chronic liver disease associated with either thrombocytopenia and/or hypoprothrombinemia. Primary outcome was the difference in perioperative bleeding complications between the two groups. Other outcome measures included all perioperative findings and complications as well-functional outcome measures. Results The study included 140 patients (93 indexed patients and 47 non-indexed). There were no significant differences between both groups in operative time, laser time and energy, auxiliary procedures, catheter time, hospital stay, and hemoglobin deficit. The need for blood transfusion was significantly more in group 2 (two patients (4.3%) versus no patients in group 1, P = 0.045). Perioperative and late postoperative complications were comparable for both groups (P = 0.634 and 0.858, respectively). There were no significant differences in the postoperative uroflow, symptoms score, and PSA reduction between the two groups (P = 0.57, 0.87, and 0.05, respectively). Conclusions XPS™-180 W GL-LP is a safe and effective technique for treatment of BPH in patients with uncorrectable bleeding tendency due to hepatic dysfunction.
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Affiliation(s)
- Ahmed M. Elshal
- Urology Department, Urology and Nephrology Center, Mansoura University, Egypt
| | - Fady K. Ghobrial
- Department of Urology, Faculty of Medicine, Damietta University, Egypt
| | - Mahmoud Laymon
- Urology Department, Urology and Nephrology Center, Mansoura University, Egypt
| | - Mohamed Elegeezy
- Department of Internal Medicine, Hepatology Unit, Mansoura University, Al Mansurah, Egypt
| | - Ahmed R. El-Nahas
- Urology Department, Urology and Nephrology Center, Mansoura University, Egypt
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Loftus TJ, Balch JA, Ruppert MM, Tighe PJ, Hogan WR, Rashidi P, Upchurch GR, Bihorac A. Aligning Patient Acuity With Resource Intensity After Major Surgery: A Scoping Review. Ann Surg 2022; 275:332-339. [PMID: 34261886 PMCID: PMC8750209 DOI: 10.1097/sla.0000000000005079] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Develop unifying definitions and paradigms for data-driven methods to augment postoperative resource intensity decisions. SUMMARY BACKGROUND DATA Postoperative level-of-care assignments and frequency of vital sign and laboratory measurements (ie, resource intensity) should align with patient acuity. Effective, data-driven decision-support platforms could improve value of care for millions of patients annually, but their development is hindered by the lack of salient definitions and paradigms. METHODS Embase, PubMed, and Web of Science were searched for articles describing patient acuity and resource intensity after inpatient surgery. Study quality was assessed using validated tools. Thirty-five studies were included and assimilated according to PRISMA guidelines. RESULTS Perioperative patient acuity is accurately represented by combinations of demographic, physiologic, and hospital-system variables as input features in models that capture complex, non-linear relationships. Intraoperative physiologic data enriche these representations. Triaging high-acuity patients to low-intensity care is associated with increased risk for mortality; triaging low-acuity patients to intensive care units (ICUs) has low value and imparts harm when other, valid requests for ICU admission are denied due to resource limitations, increasing their risk for unrecognized decompensation and failure-to-rescue. Providing high-intensity care for low-acuity patients may also confer harm through unnecessary testing and subsequent treatment of incidental findings, but there is insufficient evidence to evaluate this hypothesis. Compared with data-driven models, clinicians exhibit volatile performance in predicting complications and making postoperative resource intensity decisions. CONCLUSION To optimize value, postoperative resource intensity decisions should align with precise, data-driven patient acuity assessments augmented by models that accurately represent complex, non-linear relationships among risk factors.
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Affiliation(s)
- Tyler J. Loftus
- Department of Surgery, University of Florida Health,
Gainesville, FL, USA
- Precision and Intelligent Systems in Medicine
(Prisma), University of Florida, Gainesville, FL, USA
| | - Jeremy A. Balch
- Department of Surgery, University of Florida Health,
Gainesville, FL, USA
| | - Matthew M. Ruppert
- Department of Medicine, University of Florida Health,
Gainesville, FL, USA
- Precision and Intelligent Systems in Medicine
(Prisma), University of Florida, Gainesville, FL, USA
| | - Patrick J. Tighe
- Departments of Anesthesiology, Orthopedics, and Information
Systems/Operations Management, University of Florida Health, Gainesville, FL,
USA
| | - William R. Hogan
- Department of Health Outcomes & Biomedical Informatics,
College of Medicine, University of Florida, Gainesville, FL, USA
| | - Parisa Rashidi
- Departments of Biomedical Engineering, Computer and
Information Science and Engineering, and Electrical and Computer Engineering,
University of Florida, Gainesville, Florida, USA
- Precision and Intelligent Systems in Medicine
(Prisma), University of Florida, Gainesville, FL, USA
| | | | - Azra Bihorac
- Department of Medicine, University of Florida Health,
Gainesville, FL, USA
- Precision and Intelligent Systems in Medicine
(Prisma), University of Florida, Gainesville, FL, USA
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Loftus TJ, Ruppert MM, Ozrazgat-Baslanti T, Balch JA, Efron PA, Tighe PJ, Hogan WR, Rashidi P, Upchurch GR, Bihorac A. Association of Postoperative Undertriage to Hospital Wards With Mortality and Morbidity. JAMA Netw Open 2021; 4:e2131669. [PMID: 34757412 PMCID: PMC8581722 DOI: 10.1001/jamanetworkopen.2021.31669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE Undertriaging patients who are at increased risk for postoperative complications after surgical procedures to low-acuity hospital wards (ie, floors) rather than highly vigilant intensive care units (ICUs) may be associated with risk of unrecognized decompensation and worse patient outcomes, but evidence for these associations is lacking. OBJECTIVE To test the hypothesis that postoperative undertriage is associated with increased mortality and morbidity compared with risk-matched ICU admission. DESIGN, SETTING, AND PARTICIPANTS This longitudinal cross-sectional study was conducted using data from the University of Florida Integrated Data Repository on admissions to a university hospital. Included patients were individuals aged 18 years or older who were admitted after a surgical procedure from June 1, 2014, to August 20, 2020. Data were analyzed from April through August 2021. EXPOSURES Ward admissions were considered undertriaged if their estimated risk for hospital mortality or prolonged ICU stay (ie, ≥48 hours) was in the top quartile among all inpatient surgical procedures according to a validated machine-learning model using preoperative and intraoperative electronic health record features available at surgical procedure end time. A nearest neighbors algorithm was used to identify a risk-matched control group of ICU admissions. MAIN OUTCOMES AND MEASURES The primary outcomes of hospital mortality and morbidity were compared among appropriately triaged ward admissions, undertriaged wards admissions, and a risk-matched control group of ICU admissions. RESULTS Among 12 348 postoperative ward admissions, 11 042 admissions (89.4%) were appropriately triaged (5927 [53.7%] women; median [IQR] age, 59 [44-70] years) and 1306 admissions (10.6%) were undertriaged and matched with a control group of 2452 ICU admissions. The undertriaged group, compared with the control group, had increased median [IQR] age (64 [54-74] years vs 62 [50-73] years; P = .001) and increased proportions of women (649 [49.7%] women vs 1080 [44.0%] women; P < .001) and admitted patients with do not resuscitate orders before first surgical procedure (53 admissions [4.1%] vs 27 admissions [1.1%]); P < .001); 207 admissions that were undertriaged (15.8%) had subsequent ICU admission. In the validation cohort, hospital mortality and prolonged ICU stay estimations had areas under the receiver operating characteristic curve of 0.92 (95% CI, 0.91-0.93) and 0.92 (95% CI, 0.92-0.92), respectively. The undertriaged group, compared with the control group, had similar incidence of prolonged mechanical ventilation (32 admissions [2.5%] vs 53 admissions [2.2%]; P = .60), decreased median (IQR) total costs for admission ($26 900 [$18 400-$42 300] vs $32 700 [$22 700-$48 500]; P < .001), increased median (IQR) hospital length of stay (8.1 [5.1-13.6] days vs 6.0 [3.3-9.3] days, P < .001), and increased incidence of hospital mortality (19 admissions [1.5%] vs 17 admissions [0.7%]; P = .04), discharge to hospice (23 admissions [1.8%] vs 14 admissions [0.6%]; P < .001), unplanned intubation (45 admissions [3.4%] vs 49 admissions [2.0%]; P = .01), and acute kidney injury (341 admissions [26.1%] vs 477 admissions [19.5%]; P < .001). CONCLUSIONS AND RELEVANCE This study found that admitted patients at increased risk for postoperative complications who were undertriaged to hospital wards had increased mortality and morbidity compared with a risk-matched control group of admissions to ICUs. Postoperative undertriage was identifiable using automated preoperative and intraoperative data as features in real-time machine-learning models.
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Affiliation(s)
- Tyler J. Loftus
- Department of Surgery, University of Florida Health, Gainesville
- Precision and Intelligent Systems in Medicine Research Partnership, University of Florida, Gainesville
| | - Matthew M. Ruppert
- Precision and Intelligent Systems in Medicine Research Partnership, University of Florida, Gainesville
- Department of Medicine, University of Florida Health, Gainesville
| | - Tezcan Ozrazgat-Baslanti
- Precision and Intelligent Systems in Medicine Research Partnership, University of Florida, Gainesville
- Department of Medicine, University of Florida Health, Gainesville
| | - Jeremy A. Balch
- Department of Surgery, University of Florida Health, Gainesville
| | - Philip A. Efron
- Department of Surgery, University of Florida Health, Gainesville
| | - Patrick J. Tighe
- Department of Anesthesiology, University of Florida Health, Gainesville
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida Health, Gainesville
- Department of Information Systems and Operations Management, University of Florida Health, Gainesville
| | - William R. Hogan
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville
| | - Parisa Rashidi
- Precision and Intelligent Systems in Medicine Research Partnership, University of Florida, Gainesville
- Department of Biomedical Engineering, University of Florida, Gainesville
- Department of Computer and Information Science and Engineering, University of Florida, Gainesville
- Department of Electrical and Computer Engineering, University of Florida, Gainesville
| | | | - Azra Bihorac
- Precision and Intelligent Systems in Medicine Research Partnership, University of Florida, Gainesville
- Department of Medicine, University of Florida Health, Gainesville
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Laique S, Franco MC, Stevens T, Bhatt A, Vargo JJ, Chahal P. Clinical outcomes of endoscopic management of pancreatic fluid collections in cirrhotics vs non-cirrhotics: A comparative study. World J Gastrointest Endosc 2019; 11:403-412. [PMID: 31236193 PMCID: PMC6580308 DOI: 10.4253/wjge.v11.i6.403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 05/16/2019] [Accepted: 05/23/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Endoscopic management of symptomatic pancreatic fluid collections (PFCs) using self-expandable metal stents (SEMS) placement has emerged as an innovative therapeutic approach with excellent efficacy, safety, and relatively few adverse outcomes. However, their use has not been studied in patients with cirrhosis. Cirrhotics tend to be considered less than optimal candidates due to concern for portal hypertension and coagulopathy related complications.
AIM To compare the efficacy and safety of using SEMS for drainage of symptomatic PFCs in cirrhotic vs non-cirrhotic patients.
METHODS We conducted a retrospective comparative analysis of patients with symptomatic PFCs [pancreatic pseudocyst (PP) or walled-off necrosis (WON)] who underwent endoscopic ultrasound (EUS)-guided placement of fully covered self-expandable metals stents or lumen-apposing self-expandable metal stents. All patients were followed clinically until resolution of PFCs or death. Definition: (1) Technical success was defined as successful placement of SEMS; and (2) Clinical success was defined as complete resolution of the PFCs without additional interventions including interventional radiology or surgery. Number of procedures performed per patient, number of patients who achieved complete resolution of the PFCs without additional interventions and procedure related adverse events were recorded.
RESULTS From January 2012 to December 2017, a total of 88 patients underwent EUS-guided drainage of symptomatic PFCs. Of these, 58 non cirrhotic patients underwent plastic stent insertion for management of PFC and 30 patients, 5 with cirrhosis and 25 without cirrhosis, underwent EUS-guided transmural drainage with SEMS, including 18 (60%) PP and 12 (40%) WON. Technical success was achieved in all 30 patients. Clinical success was achieved in 60% cirrhotic patients and 92% non-cirrhotics (P = 0.12). Procedure-related adverse events were 60% in cirrhotic and 28% non-cirrhotic (P = 0.62). Moreover, fatal adverse events were statistically more common in cirrhotics compared with non-cirrhotics (0 vs 40%; P = 0.023). Successful stent removal following resolution of the PFC, was 60% in cirrhotics and 80% in non-cirrhotics (P = 0.57). Post-procedure length of hospitalization was 18.6 ± 20.3 d in cirrhotics and 5.6 ± 13.7 d in non-cirrhotics (P = 0.084).
CONCLUSION EUS-guided management of PFC using SEMS placement has a high technical and clinical success rate in non-cirrhotics. However, in cirrhotics caution must be exercised given the high morbidity and mortality as evidenced by our cohort, particularly for the endoscopic debridement of WONs. Larger, multicenter studies are warranted to further characterize the risk profile and outcomes in these patients.
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Affiliation(s)
- Sobia Laique
- Internal Medicine, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Matheus C Franco
- Digestive Disease Institute, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Tyler Stevens
- Digestive Disease Institute, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Amit Bhatt
- Digestive Disease Institute, Cleveland Clinic, Cleveland, OH 44195, United States
| | - John J Vargo
- Digestive Disease Institute, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Prabhleen Chahal
- Digestive Disease Institute, Cleveland Clinic, Cleveland, OH 44195, United States
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Subramanian KKK, Tandon M, Pandey CK, Jain P. Patients with Cirrhosis of Liver Operated for Non-transplant Surgery: A Retrospective Analysis. J Clin Transl Hepatol 2019; 7:9-14. [PMID: 30944813 PMCID: PMC6441638 DOI: 10.14218/jcth.2018.00043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 11/15/2018] [Accepted: 01/09/2019] [Indexed: 12/22/2022] Open
Abstract
Background and Aims: Patients with cirrhosis of the liver have high mortality after surgery. We investigated the mortality in patients with cirrhosis of the liver who underwent surgery other than liver transplant and applied the Mayo clinic model to predict mortality and compare with the observed mortality. We also studied the association of the observed mortality with the Child-Turcotte-Pugh (CTP) class and the model for end-stage liver disease (MELD) and model for end-stage liver disease-sodium (MELD-Na) scores. Methods: The electronic records database of our hospital was accessed to analyze the data of 133 cirrhotic patients who underwent various surgeries under general anesthesia from October 2009 to June 2017. The Mayo risk score was applied to each and used to calculate predicted mortality; the MELD and MELD-Na scores were also calculated. Telephonic interview was performed with the patients and or their relative to ascertain survival or time of death after surgery, when the information was not available from the hospital records. Results: The all-cause observed mortality rates at postoperative days 30 and 90 and at 1 year were 12%, 20.3% and 26.3% respectively. The area under the receiver operating characteristic curve values for the Mayo model as a predictor of 30-day, 90-day and 1-year mortality were 0.836, 0.828 and 0.744 respectively. Good correlation was seen for observed mortality with CTP class and with MELD and MELD-Na scores. Conclusions: The Mayo model for predicting postoperative mortality in patients with cirrhosis of the liver demonstrated good correlation in this study. The strength of prediction of mortality by Mayo risk score calculation was similar at postoperative days 30 and 90 but decreased at 1-year after the surgery. Good correlation was seen for the observed mortality with MELD, MELD-Na and CTP scores.
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Affiliation(s)
| | - Manish Tandon
- Department of Anaesthesiology, Institute of Liver and Biliary Sciences, New Delhi, India
- *Correspondence to: Manish Tandon, Department of Anaesthesiology, Institute of Liver and Biliary Sciences, D-1, Vasant kunj, New Delhi, India. Tel: +91-9871437478, Fax: +91-1146300010, E-mail:
| | - Chandra Kant Pandey
- Department of Anaesthesiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Priyanka Jain
- Department of Research, Institute of Liver & Biliary Sciences (ILBS), New Delhi, India
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Newman JM, Schiltz NK, Mudd CD, Szubski CR, Klika AK, Barsoum WK. Impact of Cirrhosis on Resource Use and Inpatient Complications in Patients Undergoing Total Knee and Hip Arthroplasty. J Arthroplasty 2016; 31:2395-2401. [PMID: 27236746 PMCID: PMC5069119 DOI: 10.1016/j.arth.2016.04.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 04/19/2016] [Accepted: 04/20/2016] [Indexed: 02/07/2023] Open
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 arthroplasty (TKA) or total hip arthroplasty (THA). 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 2 groups: (1) cirrhosis (n = 41,464) and (2) no cirrhosis (n = 5,721,297) and THA patients were divided into 2 groups: (1) cirrhosis (n = 27,401) and (2) no cirrhosis (n = 2,622,539). Patient demographics, comorbidities, perioperative complications, LOS, and incremental costs were analyzed. An additional subgroup analysis by cirrhosis etiology was performed. RESULTS Multivariable analysis revealed cirrhosis was associated with 1.55 (95% confidence interval: 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 $1857 higher costs and 0.30 days longer LOS and THA cirrhotic patients had $1497 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.
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Affiliation(s)
- Jared M. Newman
- Department of Orthopaedic Surgery, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195
| | - Nicholas K. Schiltz
- Department of Epidemiology and Biostatistics, Case Western Reserve University, 2103 Cornell Rd. Cleveland, OH 44106
| | - Christopher D. Mudd
- Department of Orthopaedic Surgery, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195
| | - Caleb R. Szubski
- Department of Orthopaedic Surgery, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195
| | - Alison K. Klika
- Department of Orthopaedic Surgery, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195
| | - Wael K. Barsoum
- Department of Orthopaedic Surgery, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195
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Nyberg EM, Batech M, Cheetham TC, Pio JR, Caparosa SL, Chocas MA, Singh A. Postoperative Risk of Hepatic Decompensation after Orthopedic Surgery in Patients with Cirrhosis. J Clin Transl Hepatol 2016; 4:83-9. [PMID: 27350938 PMCID: PMC4913079 DOI: 10.14218/jcth.2015.00049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 01/20/2016] [Accepted: 02/24/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND AND AIMS Previous studies have shown increased hepatic decompensation in patients with cirrhosis undergoing surgery. However, there are little data available in cirrhotics undergoing orthopedic surgery compared to cirrhotics who did not undergo surgery. The aim of this study was to examine the demographics, comorbid conditions, and clinical factors associated with hepatic decompensation within 90 days in cirrhotics who underwent orthopedic surgery. METHODS This is a retrospective matched cohort study. Inclusion criteria were cirrhosis diagnosis, age > 18 years, ≥ 6 months continuous health plan membership, and a procedure code for orthopedic surgery. Up to five cirrhotic controls without orthopedic surgery were matched on age, gender, and cirrhosis diagnosis date. Data abstraction was performed for demographics, socioeconomics, clinical, and decompensation data. Chart review was performed for validation. Multivariable analysis estimated relative risk of decompensation. RESULTS Eight hundred fifty-three orthopedic surgery cases in cirrhotics were matched with 4,263 cirrhotic controls. Among the cases and matched controls, the mean age was 60.5 years, and 52.2% were female. Within 90 days after surgery, cases had more decompensation compared to matched controls (12.8% vs 4.9%). Using multivariable analysis, orthopedic surgery, a 0.5 g/dL decrease in serum albumin, and a 1-unit increase in Charlson Comorbidity Index were associated with a significant increase in decompensation within 90 days of surgery. Diabetes, chronic obstructive pulmonary disease, and chronic kidney disease were seen with increased frequency in cases vs. matched controls. CONCLUSIONS Cirrhotics who underwent orthopedic surgery had a significant increase in hepatic decompensation within 90 days of surgery compared to matched controls. An incremental decrease in serum albumin and an incremental increase in the Charlson Comorbidity Index were significantly associated with hepatic decompensation after surgery.
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Affiliation(s)
- Eric M. Nyberg
- Department of Orthopaedics, Kaiser Permanente, San Diego, USA
| | - Michael Batech
- Department of Research & Evaluation, Kaiser Permanente, Pasadena, USA
| | - T. Craig Cheetham
- Department of Research & Evaluation, Kaiser Permanente, Pasadena, USA
| | - Jose R. Pio
- Department of Research & Evaluation, Kaiser Permanente, Pasadena, USA
| | - Susan L. Caparosa
- Department of Research & Evaluation, Kaiser Permanente, Pasadena, USA
| | | | - Anshuman Singh
- Department of Orthopaedics, Kaiser Permanente, San Diego, USA
- Department of Orthopaedics, University of California at San Diego, San Diego, USA
- *Correspondence to: Anshuman Singh, Department of Orthopedics, The Garfield Specialty Center, 5893 Copley Drive, San Diego, CA 92111, USA. Tel: +1-213-359-2269, E-mail:
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Sahlman P, Nissinen M, Pukkala E, Färkkilä M. Cancer incidence among alcoholic liver disease patients in Finland: A retrospective registry study during years 1996-2013. Int J Cancer 2016; 138:2616-21. [DOI: 10.1002/ijc.29995] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 12/14/2015] [Accepted: 12/22/2015] [Indexed: 12/16/2022]
Affiliation(s)
- Perttu Sahlman
- Clinic of Gastroenterology; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - Markku Nissinen
- Clinic of Gastroenterology; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - Eero Pukkala
- School of Health Sciences, University of Tampere; Tampere Finland
| | - Martti Färkkilä
- Clinic of Gastroenterology; University of Helsinki and Helsinki University Hospital; Helsinki Finland
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