Department of Medicine, University of Connecticut.
Department of Gastroenterology and Hepatology, St. Francis Hospital and Medical Center, Hartford, CT.
J Clin Gastroenterol. 2019 Oct;53(9):e371-e375. doi: 10.1097/MCG.0000000000001166.
Cirrhotic patients are at a higher risk for sustaining orthopedic fractures with a reported prevalence of 5% to 20%. Cirrhosis also affects wound healing and bleeding risk, and hence, impacts the postoperative outcomes after fracture repair. However, there is limited data available on the postoperative risk factors and clinical outcomes of fractures in patients with chronic liver disease (CLD).
Data from the National Inpatient Sample for the years 2012 to 2015 were analyzed. Patients were identified using ICD-9 codes for any fracture. ICD-9 codes for CLD were used to categorize patients into CLD and non-CLD groups. Primary outcomes included inpatient mortality, length of stay (LOS), and total hospital charges. Secondary outcomes included complications such as postoperative infection, prosthetic failure, bleeding, and improper wound healing.
A total of 931,193 patient encounters for orthopedic fractures were identified and divided into 17,388 with CLD and 913,806 without CLD (non-CLD). The inpatient mortality in patients with CLD was almost twice that of non-CLD patients (odds ratio, 1.95; 95% confidence interval, 1.8-2.1). Patients with CLD also had a longer mean LOS at 7.4±8.6 days versus 5.6±7.2 days (P<0.001) and higher total hospital charges at $76,198±99,494 versus $64,294±95,673 (P<0.001). CLD patients also had higher rates of infections, improper wound healing, and bleeding.
In this large retrospective study, CLD patients with fractures had significantly higher mortality, LOS and hospital charges. These findings correlate with the higher rates of infection, bleeding, and poorer wound healing in this population. Increased clinician awareness of these risks is a key to improving the care of CLD patients.
肝硬化患者发生骨科骨折的风险较高，报告发病率为 5%至 20%。肝硬化还会影响伤口愈合和出血风险，从而影响骨折修复后的术后结果。然而，关于慢性肝病（CLD）患者骨折的术后危险因素和临床结果的数据有限。
对 2012 年至 2015 年国家住院患者样本的数据进行了分析。使用 ICD-9 骨折代码识别患者。使用 ICD-9 CLD 代码将患者分为 CLD 和非 CLD 组。主要结局包括住院死亡率、住院时间（LOS）和总住院费用。次要结局包括术后感染、假体失败、出血和伤口愈合不良等并发症。
共确定了 931,193 例骨科骨折患者，并分为 17,388 例 CLD 患者和 913,806 例非 CLD（非 CLD）患者。CLD 患者的住院死亡率几乎是非 CLD 患者的两倍（比值比，1.95；95%置信区间，1.8-2.1）。CLD 患者的平均 LOS 也更长，为 7.4±8.6 天，而非 CLD 患者为 5.6±7.2 天（P<0.001），总住院费用也更高，为 76,198±99,494 美元，而非 CLD 患者为 64,294±95,673 美元（P<0.001）。CLD 患者的感染、伤口愈合不良和出血发生率也较高。
在这项大型回顾性研究中，患有骨折的 CLD 患者的死亡率、LOS 和住院费用明显更高。这些发现与该人群中较高的感染、出血和较差的伤口愈合率相关。提高临床医生对这些风险的认识是改善 CLD 患者护理的关键。
