Patients With Cirrhosis Have Higher Costs of Care, Longer Length of Stays, and More Perioperative Complications Following Total Knee Arthroplasty: A National Inpatient Sample-Based Study

Sreenivasulu Metikala; Nikit Venishetty; Naga Cheppalli; Hunter Jones; Varatharaj Mounsamy; Senthil Sambandam

doi:10.7759/cureus.47317

Patients With Cirrhosis Have Higher Costs of Care, Longer Length of Stays, and More Perioperative Complications Following Total Knee Arthroplasty: A National Inpatient Sample-Based Study

Cureus. 2023 Oct 19;15(10):e47317. doi: 10.7759/cureus.47317. eCollection 2023 Oct.

Authors

Sreenivasulu Metikala¹, Nikit Venishetty², Naga Cheppalli³, Hunter Jones⁴, Varatharaj Mounsamy⁵, Senthil Sambandam⁵

Affiliations

¹ Orthopaedics, Virginia Commonwealth University Health System, Richmond, USA.
² Orthopaedic Surgery, Paul L. Foster School of Medicine, El Paso, USA.
³ Orthopaedics, Veterans Affairs (VA) Hospital Albuquerque, Albuquerque, USA.
⁴ Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, USA.
⁵ Orthopaedics, University of Texas Southwestern Medical Center, Dallas, USA.

Abstract

Background Cirrhosis is a growing disease affecting millions of people in the United States annually. Many cirrhosis patients undergo significant procedures and are met with increased risks such as encephalopathy, impaired immune response, ascites, variceal bleeding, renal disease, and increased malnutrition. Many cirrhosis patients need to undergo major surgical procedures such as total knee arthroplasty (TKA); however, perioperative complications following TKA in cirrhosis patients have not been studied. The purpose of this study was to analyze the demographic characteristics and perioperative complications of cirrhosis patients following TKA. Methods Using the National Inpatient Sample (NIS) database, we looked at retrospective data from the years 2016-2019 to analyze the incidence of perioperative complications, length of stay (LOS), and the cost of care (COC) among patients undergoing TKA who were categorized as cirrhosis patients, compared with those who are not. A propensity match was conducted to consider associated comorbidities that influence perioperative complications. Results Of the 558,256 patients analyzed who underwent TKA, 1670 (0.3%) were diagnosed with cirrhosis. After matching, cirrhosis patients had a longer LOS (4.22 vs. 3.68 days, p=0.016) and COC ($90,624 vs. 80676.87, p<0.001) than patients in the control group. Moreover, cirrhosis patients had a higher likelihood of developing acute renal failure (odds ratio (OR): 3.05, 95% CI: 2.07-4.50, p<0.001), blood loss anemia (OR: 1.60, 95% CI: 1.34-1.92, p<0.001), periprosthetic fracture (OR: 3.27, 95% CI: 1.31-8.18, p=0.007), periprosthetic infection (OR: 3.14, 95% CI: 1.99-4.95, p<0.001), and blood transfusions (OR: 1.62, 95% CI: 1.12-2.35, p=0.009) than patients in the control group. Conclusion The cirrhosis group had a significantly higher COC, longer LOS, and higher rates of perioperative complications than non-cirrhosis patients. This data will help providers make informed decisions about patient care and resource allocation for cirrhosis patients undergoing TKA.

Keywords: cirrhosis; cost of care; length of stay; postoperative complications; total knee arthroplasty.