Severe cirrhosis is associated with increased surgical mortality and morbidities in patients with hip fractures: a propensity-score matched analysis using a large inpatient database

Abstract

Objective The aim of this study was to compare postoperative mortality and morbidities in patients with hip fractures undergoing surgery by Child-Pugh classes.

Summary Background Data Advanced cirrhosis is associated with increased mortality in several types of surgery, but the impact of severity of cirrhosis on postoperative outcomes in patients with hip fractures remain unclear.

Methods We analyzed data of patients with hip fracture within a large inpatient database. We performed three sets of 1:1 propensity-score matching for four groups: cases without cirrhosis, and Child-Pugh classes A, B and C. We compared in-hospital mortality, length of stay, hospitalization fee, rate of 30-day readmission and complications in the following three pairs: cases without cirrhosis vs Child-Pugh class A, Child-Pugh class A vs B, and Child-Pugh class B vs C.

Results Among 833,648 eligible cases, propensity-score matching created 1,065 pairs between cases without cirrhosis vs Child-Pugh class A, 1,012 pairs between Child-Pugh class A vs B, and 489 pairs between Child-Pugh class B vs C. In-hospital mortality did not differ between cases with cirrhosis and those with Child-Pugh A classification (1.69% vs 1.41%; RD -0.28%; 95% CI: -1.34%–0.78%). In-hospital mortality was significantly higher in patients with Child-Pugh B classification than in those with A classification (1.48% vs 5.93%; RD 4.45%; 95% CI: 2.79%–6.10%), and in those with Child-Pugh C classification compared with those with B classification (6.34% vs 28.43%; RD 22.09%; 95% CI: 17.54%–26.63%). Among cases with cirrhosis, those in more severe Child-Pugh classes had longer length of stay, higher hospitalization fees and higher ratio of complications, such as acute liver failure, upper gastrointestinal bleeding and sepsis.

Conclusions Our results could help to identify patients at high-risk of postoperative mortality and morbidity among those with both hip fracture and cirrhosis. Patients with Child-Pugh C classification may benefit from discussions about nonsurgical management, goals of care, and overall prognosis.

Mini-abstract We conducted propensity-score matched analysis to examine mortality of groups of patients with hip fractures in a national patient database according to degree of severity of cirrhosis. Patients with higher Child-Pugh class of cirrhosis was shown to be associated with higher mortality.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

Yuichi Imanaka has received research funding from JSPS KAKENHI Grant Number JP19H01075, ISHIZUE 2022 of Kyoto University, and MHLW Grant Numbers JPMH22AA2003 and JPMH21IA1005. All authors have no potential conflicts of interest to disclose.

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

This study was approved by the Ethics Committee, Graduate School of Medicine, Kyoto University (approval number: R0135), and was conducted in accordance with the Ethical Guidelines for Medical and Health Research Involving Human Subjects of the Ministry of Health, Labour and Welfare, Japan. According to these guidelines, the need for written informed consent was waived for this research because it did not utilize human biological specimens and all information used in the research has been anonymized.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

Footnotes

Yuichi Imanaka has received research funding from JSPS KAKENHI Grant Number JP19H01075, ISHIZUE 2022 of Kyoto University, and MHLW Grant Numbers JPMH22AA2003 and JPMH21IA1005.

All authors have no potential conflicts of interest to disclose.

Data Availability

All data produced in the present study are available upon reasonable request to the authors.

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