Hip Fracture Surgery in Patients With Chronic Liver Disease
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CitationMonarrez, Ruben. 2020. Hip Fracture Surgery in Patients With Chronic Liver Disease. Doctoral dissertation, Harvard Medical School.
AbstractBackground: Despite increased risk, there remains a dearth of information on outcomes and risk factors for acute postoperative complications in hip fracture patients with chronic liver disease (CLD). This study aims to characterize the nature of inpatient postoperative complications and identify predictors of postoperative morbidity.
Methods: CLD patients treated for hip fractures were identified through a retrospective search on an intramural trauma registry. Charts were reviewed for baseline demographics, preoperative labs, and outcomes.
Results: The trauma registry contained 110 CLD patients who underwent surgical fixation for hip fractures. Among CLD patients, the odds of requiring a transfusion were 3.81 [95%CI: 1.59, 9.12] if platelet-count ≤100,000/uL and 5.54 [2.33, 13.16] when Model for End-Stage Liver Disease (MELD) score >9. The odds of developing acute renal failure (ARF) in CLD patients without baseline chronic kidney disease were 6.80 [1.79-25.87] if creatinine ≥1.2 mg/dL. The odds of developing postoperative delirium were 3.97 [1.06, 14.81] when the MELD score >9. In a multivariable model, the odds of developing a composite postoperative complication—which included transfusion, ARF, delirium, or deep wound infection—were 1.29 [1.01, 1.66] with rising MELD scores. Other tools used to assess surgical risks—Charlson Comorbidity Index, Elixhauser, and American Society of Anesthesiologist scores—were not predictive.
Conclusion: CLD patients who undergo operative repair of a hip fracture experience high rates of postoperative complications which can be predicted by preoperative labs identified in this study and MELD scores; however, not by other common comorbidity indices.
Citable link to this pagehttps://nrs.harvard.edu/URN-3:HUL.INSTREPOS:37365208