Total Hip Arthroplasty in Cirrhosis is Associated with Increased Complications during the Hospital Stay, Length of Stay, and Cost of Care: A Propensity Matched Database Study

Document Type : RESEARCH PAPER

Authors

1 Department of Orthopedic and Rehabilitation University of New Mexico, Raymond Murphy Medical Centre, USA

2 Virginia Common wealth University, Richmond, VA, USA

3 Department of Orthopedics, University of Texas, Southwestern, Dallas, Texas, USA

Abstract

Objectives: The aim of the study is to evaluate the impact of cirrhosis on inpatient hospital complications and 
healthcare costs in elective Total Hip Arthroplasty (THA).
Methods: A 4-year retrospective analysis of the Nation Inpatient Sample (NIS) database, who underwent elective 
THA stratified by the presence or absence of cirrhosis was performed (2016-19). The records of specific 
postoperative complications, the cost of care (COC), and the length of stay (LOS) were evaluated by statistical 
analysis. 
Results: The NIS database identified 367,894 patients who underwent THA, of which 1,134 (0.3%) were cirrhotic. 
In the unmatched analysis, patients with cirrhosis showed significantly elevated rates (P< 0.05) of in-hospital 
complications compared to non-cirrhotic controls, including mortality (0.7% vs. 0.1%), acute renal failure (9.2% vs. 
2.5%), blood loss anemia (30.4% vs. 19.5%), pneumonia (1.1% vs. 0.3%), periprosthetic fracture (3% vs. 1.2%), 
dislocations (2.5% vs. 1.4%), infection (4.2% vs. 1%), wound dehiscence (0.8% vs. 0.1%) and blood transfusion 
(11.3% vs. 3.5%). After propensity matching, significantly higher rates of blood loss anemia (30.4% vs. 26.7%; 
P=0.05), periprosthetic dislocations (2.4% vs. 1%; P=0.008), and infections (4.2% vs. 2.7%, P=0.05) were seen in 
the cirrhotic cohort, while the rate of pulmonary embolism was significantly lower (0% vs. 0.8%, P=0.002), as was 
myocardial infarction (0.08% vs. 0.7%, P=0.017). Concerning LOS in the hospital, patients with cirrhosis stayed 
significantly longer in both the unmatched (4.2 vs. 2.3 days; P <0.001) and matched (4.2 vs. 3.68; P=0.016) controls. 
The average COC was greater in the cirrhotic group, with a mean value of $90,264 vs. $66,806.31 (P<0.001) in the 
unmatched and $90,624 vs. $80,676.87 (P=0.001) in the matched cohort.
Conclusion: Cirrhosis is associated with longer lengths of stay, higher hospital costs, and a greater risk of 
perioperative in-hospital complications such as blood loss anemia, dislocation, and infection after THA. This data 
could assist during preoperative patient counseling and improve the strategies for effectively utilizing the finite 
healthcare resources without compromising patient care and financial compensation from payers. 
 Level of evidence: IV

Keywords

Main Subjects

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The Archives of Bone and Joint Surgery
Volume 11, Issue 5
May 2023
Pages 330-336

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History

  • Receive Date: 10 October 2022
  • Revise Date: 11 December 2022
  • Accept Date: 17 January 2023

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