title: Postoperative Risk of Hepatic Decompensation after Orthopedic Surgery in Patients with Cirrhosis.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Orthopaedics, Kaiser Permanente, San Diego, USA.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Nyberg
authors.affiliation: Department of Research & Evaluation, Kaiser Permanente, Pasadena, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Batech
authors.affiliation: Department of Research & Evaluation, Kaiser Permanente, Pasadena, USA.
authors.forename: T Craig
authors.initials: TC
authors.lastname: Cheetham
authors.affiliation: Department of Research & Evaluation, Kaiser Permanente, Pasadena, USA.
authors.forename: Jose R
authors.initials: JR
authors.lastname: Pio
authors.affiliation: Department of Research & Evaluation, Kaiser Permanente, Pasadena, USA.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Caparosa
authors.affiliation: Department of Orthopaedics, Kaiser Permanente, San Diego, USA.
authors.forename: Mary Alice
authors.initials: MA
authors.lastname: Chocas
authors.affiliation: Department of Orthopaedics, Kaiser Permanente, San Diego, USA; Department of Orthopaedics, University of California at San Diego, San Diego, USA.
authors.forename: Anshuman
authors.initials: A
authors.lastname: Singh
keywords: Cirrhosis; Orthopedic surgery