Chronic Liver Disease and Cirrhosis Increase Morbidity in Geriatric Patients Treated Surgically for Hip Fractures: Analysis of the US Nationwide Inpatient Sample

Overview

Journal BMC Geriatr

Publisher Biomed Central

Specialty Geriatrics

Date 2022 Feb 24

PMID 35197007

Authors

Feng-Jen Tseng

Guo-Hau Gou

Sheng-Hao Wang

Jia-Fwu Shyu

Ru-Yu Pan

Affiliations

Soon will be listed here.

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.

Citing Articles

Prevalent osteoporosis and fracture risk in patients with hepatic cirrhosis: a systematic review and meta-analysis.

Shirinezhad A, Eshlaghi F, Salabat D, Azarboo A, Ardakani Z, Esmaeili S BMC Gastroenterol. 2025; 25(1):115.

PMID: 40000980 PMC: 11853567. DOI: 10.1186/s12876-025-03720-6.

Prognosis of Cirrhotic Patients After Osteoporotic Femoral Neck Fracture.

Muallem A, Kandel L, Ackerman Z J Clin Med. 2024; 13(22).

PMID: 39597844 PMC: 11595005. DOI: 10.3390/jcm13226701.

Prevalence and Associated Factors of Anemia Among Hospital Admitted Patients in Eastern Ethiopia.

Yusuf M, Abdurahman N, Asmerom H, Atsbaha T, Alemu A, Weldegebreal F J Blood Med. 2023; 14:575-588.

PMID: 38023805 PMC: 10657767. DOI: 10.2147/JBM.S431047.

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.

Metikala S, Venishetty N, Cheppalli N, Jones H, Mounsamy V, Sambandam S Cureus. 2023; 15(10):e47317.

PMID: 38021633 PMC: 10656929. DOI: 10.7759/cureus.47317.

Use of the Shizuoka Hip Fracture Prognostic Score (SHiPS) to Predict Long-Term Mortality in Patients With Hip Fracture in Japan: A Cohort Study Using the Shizuoka Kokuho Database.

Ohata E, Nakatani E, Kaneda H, Fujimoto Y, Tanaka K, Takagi A JBMR Plus. 2023; 7(6):e10743.

PMID: 37283648 PMC: 10241087. DOI: 10.1002/jbm4.10743.

References

Johnell O, Kanis J . An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int. 2006; 17(12):1726-33. DOI: 10.1007/s00198-006-0172-4. View

Parikh N, Chang Y, Tapper E, Mathur A . Outcomes of Patients With Cirrhosis Undergoing Orthopedic Procedures: An Analysis of the Nationwide Inpatient Sample. J Clin Gastroenterol. 2018; 53(9):e356-e361. PMC: 6443495. DOI: 10.1097/MCG.0000000000001091. View

Liang J, Meng W, Yang J, Li S, Zhong M, Hou X . The association between liver cirrhosis and fracture risk: A systematic review and meta-analysis. Clin Endocrinol (Oxf). 2018; 89(4):408-413. DOI: 10.1111/cen.13762. View

Williams S, Chastek B, Sundquist K, Barrera-Sierra S, Leader Jr D, Weiss R . Economic burden of osteoporotic fractures in US managed care enrollees. Am J Manag Care. 2020; 26(5):e142-e149. DOI: 10.37765/ajmc.2020.43156. View

Cummings S, Melton L . Epidemiology and outcomes of osteoporotic fractures. Lancet. 2002; 359(9319):1761-7. DOI: 10.1016/S0140-6736(02)08657-9. View

Otete H, Deleuran T, Fleming K, Card T, Aithal G, Jepsen P . Hip fracture risk in patients with alcoholic cirrhosis: A population-based study using English and Danish data. J Hepatol. 2018; 69(3):697-704. DOI: 10.1016/j.jhep.2018.04.002. View

Florschutz A, Langford J, Haidukewych G, Koval K . Femoral neck fractures: current management. J Orthop Trauma. 2015; 29(3):121-9. DOI: 10.1097/BOT.0000000000000291. View

Nakchbandi I . Osteoporosis and fractures in liver disease: relevance, pathogenesis and therapeutic implications. World J Gastroenterol. 2014; 20(28):9427-38. PMC: 4110574. DOI: 10.3748/wjg.v20.i28.9427. View

Newman J, Schiltz N, Mudd C, Szubski C, Klika A, Barsoum W . Impact of Cirrhosis on Resource Use and Inpatient Complications in Patients Undergoing Total Knee and Hip Arthroplasty. J Arthroplasty. 2016; 31(11):2395-2401. PMC: 5069119. DOI: 10.1016/j.arth.2016.04.011. View

10.

Montomoli J, Erichsen R, Gammelager H, Pedersen A . Liver disease and mortality among patients with hip fracture: a population-based cohort study. Clin Epidemiol. 2018; 10:991-1000. PMC: 6110281. DOI: 10.2147/CLEP.S168237. View

11.

Ju D, Rajaee S, Mirocha J, Lin C, Moon C . Nationwide Analysis of Femoral Neck Fractures in Elderly Patients: A Receding Tide. J Bone Joint Surg Am. 2017; 99(22):1932-1940. DOI: 10.2106/JBJS.16.01247. View

12.

Padron-Monedero A, Lopez-Cuadrado T, Galan I, Martinez-Sanchez E, MARTIN P, Fernandez-Cuenca R . Effect of comorbidities on the association between age and hospital mortality after fall-related hip fracture in elderly patients. Osteoporos Int. 2017; 28(5):1559-1568. DOI: 10.1007/s00198-017-3926-2. View

13.

Chang C, Chang C, Wang Y, Hu C, Chang Y, Hsieh P . Increased incidence, morbidity, and mortality in cirrhotic patients with hip fractures: A nationwide population-based study. J Orthop Surg (Hong Kong). 2020; 28(3):2309499020918032. DOI: 10.1177/2309499020918032. View

14.

Brauer C, Coca-Perraillon M, Cutler D, Rosen A . Incidence and mortality of hip fractures in the United States. JAMA. 2009; 302(14):1573-9. PMC: 4410861. DOI: 10.1001/jama.2009.1462. View

15.

Rapp K, Buchele G, Dreinhofer K, Bucking B, Becker C, Benzinger P . Epidemiology of hip fractures : Systematic literature review of German data and an overview of the international literature. Z Gerontol Geriatr. 2018; 52(1):10-16. PMC: 6353815. DOI: 10.1007/s00391-018-1382-z. View

16.

Grau L, Zachwieja E, Summers S, Massel D, Ong A, Hernandez V . Hepatitis C is an Independent Risk Factor for Perioperative Complications and Nonroutine Discharge in Patients Treated Surgically for Hip Fractures. J Orthop Trauma. 2018; 32(11):565-572. DOI: 10.1097/BOT.0000000000001286. View

17.

Christensen J, Aasbrenn M, Castillo L, Ekmann A, Jensen T, Pressel E . Predictors of Acute Kidney Injury After Hip Fracture in Older Adults. Geriatr Orthop Surg Rehabil. 2020; 11:2151459320920088. PMC: 7160769. DOI: 10.1177/2151459320920088. View

18.

Chen T, Lin C, Shih C, Huang Y, Yeh C, Wu C . Risk and adverse outcomes of fractures in patients with liver cirrhosis: two nationwide retrospective cohort studies. BMJ Open. 2017; 7(10):e017342. PMC: 5640047. DOI: 10.1136/bmjopen-2017-017342. View

19.

Hong S, Kim T, Yoo J, Kim J, Kim S, Kim H . Acute kidney injury can predict in-hospital and long-term mortality in elderly patients undergoing hip fracture surgery. PLoS One. 2017; 12(4):e0176259. PMC: 5398695. DOI: 10.1371/journal.pone.0176259. View

20.

Marks R . Hip fracture epidemiological trends, outcomes, and risk factors, 1970-2009. Int J Gen Med. 2010; 3:1-17. PMC: 2866546. View