Liver Disease Increases the Risk of Postoperative Complications in Patients Undergoing Aseptic Revision Total Hip and Knee Arthroplasty

IF 1.5 Q3 ORTHOPEDICS Arthroplasty Today Pub Date : 2024-09-21 DOI:10.1016/j.artd.2024.101516

Matthew J. Kinnard MD , Jordan S. Cohen MD , Theodore Quan MD , Jared R.H. Foran MD , Neil P. Sheth MD, FACS

{"title":"Liver Disease Increases the Risk of Postoperative Complications in Patients Undergoing Aseptic Revision Total Hip and Knee Arthroplasty","authors":"Matthew J. Kinnard MD , Jordan S. Cohen MD , Theodore Quan MD , Jared R.H. Foran MD , Neil P. Sheth MD, FACS","doi":"10.1016/j.artd.2024.101516","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>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).</p></div><div><h3>Methods</h3><p>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.</p></div><div><h3>Results</h3><p>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.</p></div><div><h3>Conclusions</h3><p>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.</p></div><div><h3>Level of evidence</h3><p>This is retrospective cohort study and is level 3 evidence.</p></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"29 ","pages":"Article 101516"},"PeriodicalIF":1.5000,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2352344124002012/pdfft?md5=e8fce76849b933fe81011347c625069b&pid=1-s2.0-S2352344124002012-main.pdf","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Arthroplasty Today","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2352344124002012","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ORTHOPEDICS","Score":null,"Total":0}

引用次数: 0

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.

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

肝病会增加无菌翻修全髋关节和膝关节置换术患者术后并发症的风险

背景由于肝脏疾病对多器官的影响，患有肝脏疾病的手术患者围手术期并发症的风险增加。随着翻修全髋关节和膝关节置换手术的增加，确定肝病对这类患者的影响非常重要。本研究的目的是评估潜在肝病对翻修全关节成形术（TJA）术后结果的影响。方法利用国家外科质量改进计划数据库识别2006-2019年间接受无菌翻修TJA手术的患者，并根据肝病对其进行分组。通过计算终末期肝病模型-钠评分来评估是否存在肝病。终末期肝病模型-钠评分为> 10的患者被归类为患有基础肝病。结果在接受翻修全髋关节置换术的7102名患者中，11.6%的患者患有肝病。在接受翻修全膝关节置换术的8378名患者中，8.4%的患者患有肝病。经多变量回归分析调整后，与无肝病患者相比，接受翻修全髋关节置换术或翻修全膝关节置换术的肝病患者发生主要并发症、伤口并发症、化脓性并发症、需要输血的出血、住院时间延长和再次入院的风险增加。结论肝病患者在翻修TJA术后并发症风险增加，应采用多学科团队方法对这些易感患者进行术前优化和术后管理，以改善预后，降低并发症的发生率和严重程度。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文去求助

来源期刊

Arthroplasty Today Medicine-Surgery

CiteScore

2.90

自引率

0.00%

发文量

258

审稿时长

40 weeks

期刊介绍： Arthroplasty Today is a companion journal to the Journal of Arthroplasty. The journal Arthroplasty Today brings together the clinical and scientific foundations for joint replacement of the hip and knee in an open-access, online format. Arthroplasty Today solicits manuscripts of the highest quality from all areas of scientific endeavor that relate to joint replacement or the treatment of its complications, including those dealing with patient outcomes, economic and policy issues, prosthetic design, biomechanics, biomaterials, and biologic response to arthroplasty. The journal focuses on case reports. It is the purpose of Arthroplasty Today to present material to practicing orthopaedic surgeons that will keep them abreast of developments in the field, prove useful in the care of patients, and aid in understanding the scientific foundation of this subspecialty area of joint replacement. The international members of the Editorial Board provide a worldwide perspective for the journal''s area of interest. Their participation ensures that each issue of Arthroplasty Today provides the reader with timely, peer-reviewed articles of the highest quality.