Dataset Information

Chronic liver disease and cirrhosis increase morbidity in geriatric patients treated surgically for hip fractures: analysis of the US Nationwide Inpatient Sample.

ABSTRACT:

Background

This study aimed to evaluate the impact of chronic liver disease and cirrhosis on inpatient outcomes of geriatric hip fracture surgery.

Materials and methods

Using population-based retrospective study design, this study extracted data from the US Nationwide Inpatient Sample (NIS) database 2005-2014, identifying patients aged ≥ 65 years undergoing hip fracture repair. Main outcomes were in-hospital mortality, any/specific complications, non-routine discharge, extended length of stay (LOS) and hospital costs. Associations between cirrhosis, non-cirrhotic chronic liver disease and outcomes were determined using regression analysis.

Results

Data of 347,363 hip fracture patients included 344,035 without liver disease, 1257 with non-cirrhotic chronic liver disease and 2,071 with cirrhosis. After adjustments, non-cirrhotic chronic liver disease was significantly associated with non-routine discharge (OR: 1.247, 95% CI: 1.038-1.498), acute kidney injury (OR: 1.266, 95% CI: 1.039-1.541), extended LOS (OR: 1.285, 95% CI: 1.122-1.473) and hospital costs (beta: 9173.42, 95% CI: 6925.9-11,420.95) compared to no liver disease; while cirrhosis was significantly associated with higher risk of in-hospital mortality (OR: 2.325, 95% CI: 1.849-2.922), any complication (OR: 1.295, 95% CI: 1.143-1.467), acute kidney injury (OR: 1.242, 95% CI: 1.177-1.433), non-routine discharge (OR: 1.650, 95% CI: 1.412-1.928), extended LOS (OR: 1.405, 95% CI: 1.263-1.562) and hospital costs (beta: 6680.24, 95% CI: 4921.53-8438.95) compared to no liver disease.

Conclusion

In geriatric hip fracture patients undergoing surgical repair, non-cirrhotic chronic liver disease and cirrhosis independently predict non-routine discharge, acute kidney injury, prolonged LOS and greater hospital costs, and cirrhosis is also significantly associated with greater risk of any complication and in-hospital mortality.

SUBMITTER: Tseng FJ

PROVIDER: S-EPMC8867787 | biostudies-literature | 2022 Feb

REPOSITORIES: biostudies-literature

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Publications

Chronic liver disease and cirrhosis increase morbidity in geriatric patients treated surgically for hip fractures: analysis of the US Nationwide Inpatient Sample.

Tseng Feng-Jen FJ Gou Guo-Hau GH Wang Sheng-Hao SH Shyu Jia-Fwu JF Pan Ru-Yu RY

BMC geriatrics 20220223 1

<h4>Background</h4>This study aimed to evaluate the impact of chronic liver disease and cirrhosis on inpatient outcomes of geriatric hip fracture surgery.<h4>Materials and methods</h4>Using population-based retrospective study design, this study extracted data from the US Nationwide Inpatient Sample (NIS) database 2005-2014, identifying patients aged ≥ 65 years undergoing hip fracture repair. Main outcomes were in-hospital mortality, any/specific complications, non-routine discharge, extended le ...[more]

PMID: 35197007

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Project description:BackgroundHip fractures frequently necessitate hospitalization, especially among patients aged 75 and above who might concurrently suffer from aortic stenosis (AS). This study focuses on postoperative outcomes, potential determinants of morbidity and mortality, as well as evolving trends in patients with AS undergoing surgical repair of hip fractures.MethodsA retrospective analysis of the Nationwide Inpatient Sample from 2008 to 2019 was conducted. Hip fracture cases were identified, and a subgroup with AS was isolated using the ICD-9 and ICD-10 diagnostic codes. We compared baseline characteristics, postoperative in-hospital outcomes and trends in mortality and morbidity between patients with and without AS.ResultsFrom the dataset, 2,834,919 patients with hip fracture were identified on weighted analysis. Of these, 94,270 (3.3%) were found to have concurrent AS. The AS cohort was characterized by higher mean age and elevated burden of cardiovascular comorbidities, such as coronary artery disease, peripheral vascular disease, pulmonary hypertension, congestive heart failure and cardiac arrhythmias. Postoperative mortality following hip fracture surgery was greater in the AS groups compared to non-AS group (3.3% vs 1.57%, p < 0.001). Risk factors such as congestive heart failure (OR, 2.3[CI, 2.1-2.6]), age above 85 years (OR, 3.2[CI, 2.2-4.7]), cardiac arrhythmias (OR, 2.4[CI, 2.2-2.6]), end-stage renal disease (OR, 3.4[CI, 2.7-4.1]), malnutrition (OR, 2.3[CI, 2.1-2.7]) and AS (OR, 1.2[CI, 1.08-1.5] were associated with increased adjusted odds of postoperative mortality. AS was linked to higher adjusted odds of postoperative mortality (OR, 1.2 [CI, 1.1-1.5]) and complications such as acute myocardial infarction (OR, 1.2 [CI, 1.01-1.4]), cardiogenic shock (OR, 2.0[CI, 1.4-2.9]) and acute renal failure (OR, 1.1[CI, 1.02-1.2]). While hospital stay duration was comparable in both groups (average 5 days), the AS group incurred higher costs (mean $50,673 vs $44,607). The presence of acute heart failure in patients with AS and hip fracture significantly increased mortality, hospital stay, and cost. A notable decline in postoperative in-hospital mortality was observed in both groups from 2008-2019 though the rate of major in-hospital complications rose.ConclusionAS significantly influences postoperative in-hospital mortality and complication rates in hip fracture patients. While a reduction in postoperative mortality was observed in both AS and non-AS cohorts, the incidence of major in-hospital complications increased across both groups.

Project description:BackgroundTo study the impact of valvular heart disease (VHD) on hip replacement, particularly the clinical impactions of aortic stenosis before total/partial hip arthroplasty.MethodsThis was a retrospective cohort study. Data on patients who had undergone hip replacement from 2005 to 2014 were extracted from the NIS database. Independent t test and chi-square test were used to analyze the essential characteristics of patients. Multivariate regression was used to estimate the correlation among demographics, comorbidities, complications, hospitalization costs, and time.ResultsVHD accounted for 5.56% and AS accounted for 0.03% of the patients before hip replacement surgeries. Patients with VHD before hip replacement are related to the following characteristics: female patients (odds ratio [OR] = 1.15 [1.12-1.18]), elective admission (OR = 0.78 [0.76-0.80]), Charlson Comorbidity Index ≥3 (OR = 1.06 [1.03-1.08]), large-volume hospitals (OR = 1.13 [1.1-1.2]), teaching hospitals (OR = 5 4.4 [2.9-6.7]), and hospital location in urban areas (OR = 1.22 [1.2-1.3]). In addition, VHD is a risk factor for mortality and some acute postoperative medical complications, such as acute cardiac event (OR = 2.96 [2.87-3.04]), acute pulmonary edema (OR = 1.13 [1.06-1.21]), acute cerebrovascular event (OR = 1.22 [1.16-1.74]), and acute renal failure (OR = 1.22 [1.17-1.27]). It also has an impact on DVT/PE (OR = 0.89 [0.8-0.99]). Patients with AS before hip replacement have basic demographic characteristics like those of hip replacement patients with valvular disease. Patients with AS are older than those without AS before surgery (OR = 3.28 [2.27-4.75) and are related to the following characteristics: female patients (OR = 1.92 [1.32-2.8]) and elective admission (OR = 0.51 [0.36-0.75]). The perioperative period is limited to acute postoperative complications, such as acute cardiac events (OR = 2.50 [1.76-3.53]) and acute hepatic failure (OR = 7.69 [1.8-32.89]). Both valvular diseases and AS are associated with a higher mortality rate and hospitalization cost.ConclusionVHD independently predicted mortality rate and surgical and medical complications after total/partial hip arthroplasty.

Project description:ObjectivesGeriatric hip fractures, known as osteoporotic fractures, are associated with nutritional deficiencies such as vitamin D (VitD). However, the relationship between other vitamins besides VitD and fracture is still lacking. Therefore, we intended to identify various vitamin levels and deficiencies in elderly patients with hip fractures and compared those with healthy elderly individuals.MethodsA total of 210 geriatric hip fracture continuous patients and 402 healthy elderly individuals aged ≥65 years old and with complete serum vitamin records were enrolled in this study. The levels of serum VitA, VitB1, VitB2, VitB3, VitB5, VitB6, VitB9, VitE, VitK1, and 25-hydroxyvitamin D (25-HO-VitD) and nutritional markers, such as prognostic nutritional index (PNI), were compared between geriatric hip fracture patients and healthy control. The correlation between vitamin level and the nutritional markers was explored. A multiple linear regression analysis was conducted to assess the association between vitamin levels and hip fracture.ResultsThe levels of VitA, VitB1, VitB3, VitB5, VitB9, 25-HO-VitD, 25-HO-VitD3, E, and K1 were all lower in the hip fracture group (p < 0.05). More than 80% of older persons suffered 25-HO-VitD deficiency in both healthy and fracture groups. A positive correlation between levels of VitA and nutritional markers existed in the fracture and healthy groups. In regression analysis, the association strength between standardized vitamin levels and fracture was the most significant in VitB9 (β = -0.94; 95%CI, -1.15 to -0.73; p < 0.001), VitA (β = -0.83; 95%CI, -1.04 to -0.61; p < 0.001), and VitK1 (β = -0.80; 95%CI, -1.02 to -0.58; p < 0.001), with no significant statistic difference found in VitB2, VitB9, 25-HO-VitD2, and 25-HO-VitD3.ConclusionVitamin D deficiency is common in elderly people with or without fracture. The levels of VitA, VitB9, and VitK1, instead of VitD, were much lower in fracture patients than in the healthy control, even controlling age and gender. VitA is a potential target for hip fracture prevention.

Dataset Information

Chronic liver disease and cirrhosis increase morbidity in geriatric patients treated surgically for hip fractures: analysis of the US Nationwide Inpatient Sample.

Background

Materials and methods

Results

Conclusion

Publications

Chronic liver disease and cirrhosis increase morbidity in geriatric patients treated surgically for hip fractures: analysis of the US Nationwide Inpatient Sample.

Similar Datasets

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