Kinnard Matthew J, Cohen Jordan S, Quan Theodore, Foran Jared R H, Sheth Neil P
Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA.
Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA.
Arthroplast Today. 2024 Sep 21;29:101516. doi: 10.1016/j.artd.2024.101516. eCollection 2024 Oct.
Due to the multiorgan effects of liver disease, surgical patients with liver disease have an increased risk of perioperative complications. With revision total hip and knee arthroplasty surgeries increasing, it is important to determine the effects of liver disease in this patient population. The purpose of this study was to evaluate the impact of underlying liver disease on postoperative outcomes following revision total joint arthroplasty (TJA).
The National Surgical Quality Improvement Program database was used to identify patients undergoing aseptic revision TJA from 2006-2019 and group them based on liver disease. The presence of liver disease was assessed by calculating the Model for End-Stage Liver Disease-Sodium score. Patients with a Model for End-Stage Liver Disease-Sodium score of > 10 were classified as having underlying liver disease. In this analysis, differences in demographics, comorbidities, and postoperative complications were assessed.
Of 7102 patients undergoing revision total hip arthroplasty, 11.6% of the patients had liver disease. Of 8378 patients undergoing revision total knee arthroplasty, 8.4% of the patients had liver disease. Following adjustment on multivariable regression analysis, patients with liver disease undergoing revision total hip arthroplasty or revision total knee arthroplasty had an increased risk of major complications, wound complications, septic complications, bleeding requiring transfusion, extended length of stay, and readmission compared to those without liver disease.
Patients with liver disease have an increased risk of complications following revision TJA. A multidisciplinary team approach should be employed for preoperative optimization and postoperative management of these vulnerable patients to improve outcomes and decrease the incidence and severity of complications.
This is retrospective cohort study and is level 3 evidence.
由于肝脏疾病具有多器官影响，患有肝脏疾病的外科手术患者围手术期并发症风险增加。随着全髋关节和全膝关节翻修手术的增多，确定肝脏疾病对该患者群体的影响很重要。本研究的目的是评估潜在肝脏疾病对全关节置换翻修术（TJA）术后结局的影响。
利用国家外科质量改进计划数据库识别2006年至2019年接受无菌性TJA翻修手术的患者，并根据肝脏疾病对他们进行分组。通过计算终末期肝病-钠评分模型来评估肝脏疾病的存在情况。终末期肝病-钠评分>10分的患者被分类为患有潜在肝脏疾病。在本分析中，评估了人口统计学、合并症和术后并发症的差异。
在7102例接受全髋关节翻修术的患者中，11.6%的患者患有肝脏疾病。在8378例接受全膝关节翻修术的患者中，8.4%的患者患有肝脏疾病。在多变量回归分析进行调整后，与无肝脏疾病的患者相比，接受全髋关节翻修术或全膝关节翻修术的肝脏疾病患者发生重大并发症、伤口并发症、感染性并发症、需要输血的出血、住院时间延长和再入院的风险增加。
肝脏疾病患者在TJA翻修术后并发症风险增加。对于这些脆弱患者的术前优化和术后管理，应采用多学科团队方法，以改善结局并降低并发症的发生率和严重程度。
这是一项回顾性队列研究，为3级证据。
