Chowdhury Ritam, Chaudhary Muhammad Ali, Sturgeon Daniel J, Jiang Wei, Yau Allan L, Koehlmoos Tracey P, Haider Adil H, Schoenfeld Andrew J
Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA, 02111, USA.
Arch Orthop Trauma Surg. 2017 Sep;137(9):1181-1186. doi: 10.1007/s00402-017-2742-7. Epub 2017 Jul 3.
The impact of hepatitis C virus (HCV) infection on outcomes following major orthopaedic interventions, such as joint arthroplasty or spine surgery, has not been effectively studied in the past. Most prior studies are impaired by small samples, limited surveillance for adverse events, or the potential for selection bias to confound results. In this context, we sought to evaluate the impact of HCV infection on 90-day outcomes following joint arthroplasty or spine surgery using propensity-matched techniques.
This study utilized 2006-2014 claims from TRICARE insurance. Adults who received spine surgical procedures, total knee and hip arthroplasty were identified. Covariates included demographic factors, a diagnosis of HCV and medical co-morbidities defined by International Classification of Disease-9th revision (ICD-9) code. Outcomes consisted of 30- and 90-day mortality, complications and readmission. A propensity score was used to balance the cohorts with logistic regression techniques employed to determine the influence of HCV infection on post-operative outcomes.
The propensity-matched cohort consisted of 2262 patients (1131 with and without HCV). Following logistic regression, patients with HCV were found to have increased odds of 30-day complications (OR 1.87; 95% CI 1.33, 2.64; p < 0.001), 90-day complications (OR 1.55; 95% CI 1.16, 2.08; p = 0.003) and 30-day readmission (OR 1.46; 95% CI 1.04, 2.05; p = 0.03).
HCV infection was found to increase the risk of complication and readmission following spine surgery and total joint arthroplasty. Patients should be counseled on their increased risk prior to surgery. Health systems that treat a higher percentage of patients with HCV need to consider the increased risk of complications and readmission when negotiating with insurance carriers.
过去尚未有效研究丙型肝炎病毒（HCV）感染对重大骨科手术（如关节置换术或脊柱手术）术后结局的影响。大多数先前的研究受到样本量小、不良事件监测有限或存在选择偏倚可能混淆结果的影响。在此背景下，我们试图使用倾向匹配技术评估HCV感染对关节置换术或脊柱手术后90天结局的影响。
本研究利用了2006 - 2014年TRICARE保险的理赔数据。确定接受脊柱手术、全膝关节和髋关节置换术的成年人。协变量包括人口统计学因素、HCV诊断以及由国际疾病分类第九版（ICD - 9）编码定义的合并症。结局包括30天和90天死亡率、并发症及再入院情况。使用倾向评分通过逻辑回归技术平衡队列，以确定HCV感染对术后结局的影响。
倾向匹配队列由2262名患者组成（1131名有HCV感染，1131名无HCV感染）。经过逻辑回归分析，发现HCV感染患者出现30天并发症的几率增加（比值比[OR] 1.87；95%置信区间[CI] 1.33，2.64；p < 0.001）、90天并发症（OR 1.55；95% CI 1.16，2.08；p = 0.003）以及30天再入院（OR 1.46；95% CI 1.04，2.05；p = 0.03）。
发现HCV感染会增加脊柱手术和全关节置换术后并发症及再入院的风险。术前应向患者告知其风险增加的情况。治疗HCV感染患者比例较高的医疗系统在与保险公司协商时需要考虑并发症和再入院风险增加的问题。
