Perioperative Morbidity in Cirrhotic Patients Undergoing Orthopedic Surgery

Background/Aims: Previous studies have shown an increased risk of morbidity and mortality in cirrhotic patients undergoing surgery. However, there is a paucity of studies evaluating the perioperative risks of cirrhotics who undergo orthopedic surgery. The aim of this study was to examine outcomes in cirrhotic patients who have undergone orthopedic surgery. Methods: This is a retrospective matched-cohort study using data from Kaiser Permanente Southern California. Study participants received a diagnosis for cirrhosis from 1/1/2003 through 12/31/2013, and initial case selection criteria included age \u3e 18 years, ≥ 6 months continuous health plan membership, and a procedure code for orthopedic surgery. At least 3 and up to 5 controls were optimally matched based on age, gender and cirrhosis diagnosis date. Data abstraction and summary were subsequently performed for demographic, socioeconomic, comorbid history and decompensation events data. Decompensation events included new onset ascites, variceal bleeding and hepatic encephalopathy. Multivariable conditional logistic regression estimated the risk of decompensation from surgery. Results: We matched 4,263 eligible controls with 853 cirrhotic surgical patients. Mean age of the cohort was 60.5 (standard deviation: 11.44) years and 52.2% were female. Within 90 days after surgery, cases had more decompensation events compared to matched controls (24.1% vs. 19.1%). Discussion: In this large database study including patients from a large managed care organization, cirrhotics experienced more decompensation within 90 days after orthopedic surgery compared to matched controls. Decompensation events result in significant increases in health care costs and utilization. Further, the increased morbidity seen in cirrhotics is a potential cause of quality issues for the managed care organization. Examination and mitigation of the factors, such as surgery, that can result in decompensation may help improve systems for better quality of care