Chronic liver disease tied to worse outcomes, higher complications in patients with fractures
Mortality, length of stay (LOS) and hospital charges are significantly higher in chronic liver disease (CLD) patients with fractures, a recent study has shown. These findings are also associated with increased infection, bleeding and poorer wound healing.
Of the 931,193 patients who presented with orthopaedic fractures, 17,388 had CLD and 913,806 had no CLD (non-CLD). Those with CLD were almost twice as likely to succumb to death than non-CLD patients (odds ratio, 1.95, 95 percent CI, 1.8–2.1).
Patients with CLD vs non-CLD also had a longer mean LOS (7.4±8.6 vs 5.6±7.2 days; p<0.001) and higher total hospital charges ($76,198±99,494 vs $64,294±95,673; p<0.001). Moreover, rates of infections, bleeding and improper wound healing were higher among CLD patients.
“Increased clinician awareness of these risks is a key to improving the care of CLD patients,” the authors said.
This study obtained and analysed data from the National Inpatient Sample for the years 2012 to 2015. ICD-9 codes for any fracture were used to identify patients, while codes for CLD were used to categorize them into CLD and non-CLD groups.
Inpatients mortality, LOS and total hospital charges were the primary outcomes, while secondary outcomes were complications including postoperative infection, prosthetic failure, bleeding and improper wound healing.
“Cirrhotic patients are at a higher risk for sustaining orthopedic fractures with a reported prevalence of 5–20 percent,” the authors said. “Cirrhosis also affects wound healing and bleeding risk, and hence, impacts the postoperative outcomes after fracture repair.”