Total Hip Arthroplasty in Cirrhosis is Associated with Increased Complications during the Hospital Stay, Length of Stay, and Cost of Care: A Propensity Matched Database Study

Objectives: The aim of the study is to evaluate the impact of cirrhosis on inpatient hospital complications and healthcare costs in elective Total Hip Arthroplasty (THA).

Methods: A 4-year retrospective analysis of the Nation Inpatient Sample (NIS) database, who underwent elective THA stratified by the presence or absence of cirrhosis was performed (2016-19). The records of specific postoperative complications, the cost of care (COC), and the length of stay (LOS) were evaluated by statistical analysis.

Results: The NIS database identified 367,894 patients who underwent THA, of which 1,134 (0.3%) were cirrhotic. In the unmatched analysis, patients with cirrhosis showed significantly elevated rates (P< 0.05) of in-hospital complications compared to non-cirrhotic controls, including mortality (0.7% vs. 0.1%), acute renal failure (9.2% vs. 2.5%), blood loss anemia (30.4% vs. 19.5%), pneumonia (1.1% vs. 0.3%), periprosthetic fracture (3% vs. 1.2%), dislocations (2.5% vs. 1.4%), infection (4.2% vs. 1%), wound dehiscence (0.8% vs. 0.1%) and blood transfusion (11.3% vs. 3.5%). After propensity matching, significantly higher rates of blood loss anemia (30.4% vs. 26.7%; P=0.05), periprosthetic dislocations (2.4% vs. 1%; P=0.008), and infections (4.2% vs. 2.7%, P=0.05) were seen in the cirrhotic cohort, while the rate of pulmonary embolism was significantly lower (0% vs. 0.8%, P=0.002), as was myocardial infarction (0.08% vs. 0.7%, P=0.017). Concerning LOS in the hospital, patients with cirrhosis stayed significantly longer in both the unmatched (4.2 vs. 2.3 days; P <0.001) and matched (4.2 vs. 3.68; P=0.016) controls. The average COC was greater in the cirrhotic group, with a mean value of $90,264 vs. $66,806.31 (P<0.001) in the unmatched and $90,624 vs. $80,676.87 (P=0.001) in the matched cohort.

Conclusion: Cirrhosis is associated with longer lengths of stay, higher hospital costs, and a greater risk of perioperative in-hospital complications such as blood loss anemia, dislocation, and infection after THA. This data could assist during preoperative patient counseling and improve the strategies for effectively utilizing the finite healthcare resources without compromising patient care and financial compensation from payers.