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Outcomes of Patients With Cirrhosis Undergoing Orthopedic Procedures

An Analysis of the Nationwide Inpatient Sample

Parikh, Neehar D. MD, MS*; Chang, Yu-Hui MPH, PhD; Tapper, Elliot B. MD*; Mathur, Amit K. MD

Journal of Clinical Gastroenterology: October 2019 - Volume 53 - Issue 9 - p e356–e361
doi: 10.1097/MCG.0000000000001091
ONLINE ARTICLES: Original Articles

Introduction: The population of patients with cirrhosis is growing and shifting toward a more elderly demographic and thus are at risk of developing orthopedic complications. There is lack of data on safety of orthopedic procedures in this population.

Methods: We performed an analysis of the Nationwide Inpatient Sample from 2005 to 2011 for patients undergoing hip arthroplasty, knee arthroplasty, and spinal laminectomy/fusion, stratified by presence of cirrhosis. The primary endpoint was in-hospital mortality and secondary endpoints included length of stay (LOS) and costs.

Results: There were 693,610 inpatient stays for orthopedic procedures conducted during the study period, with 3014 (0.43%) patients coded as having cirrhosis. Patients with cirrhosis had a lower median age (62 vs. 66 y; P<0.001) and were more likely to be male (52.3% vs. 41.1%; P<0.001). The inpatient mortality rate was significantly higher in patients with cirrhosis (2.4% vs. 0.4%; P<0.001) as was median LOS (4 vs. 3 d; P<0.001) and mean costs ($19,321 vs. $18,833; P<0.001). Patients with decompensated cirrhosis (vs. compensated cirrhosis) had significantly higher inpatient mortality rates (5.8% vs. 1.1%; P<0.001) with higher LOS and costs (P<0.001). On multivariable analysis, cirrhosis was associated with an increased risk of mortality (odds ratio, 4.22; 95% confidence interval, 2.92-6.10). Hospital cirrhosis volume was inversely associated with mortality, while hospital orthopedic procedure volumes had an inconsistent impact on outcomes.

Conclusions: Inpatient orthopedic procedures in patients with cirrhosis result in high postoperative mortality, LOS, and costs. Careful patient selection is warranted to optimize cirrhosis patient postoperative outcomes.

*Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI

Department of Surgery, Mayo Clinic, Scottsdale, AZ

The authors declare that they have nothing to disclose.

Address correspondence to: Neehar D. Parikh, MD, MS, Division of Gastroenterology and Hepatology, University of Michigan, SPC 3912 Taubman Center, 1500 East Medical Center Drive; Ann Arbor, MI, 48109 (e-mail:

Received April 17, 2018

Accepted June 7, 2018

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