Peer-reviewed article
Association of cirrhosis severity with outcomes after hip fracture repairs: A propensity-score matched analysis using a large inpatient database.
Hamada O, Tsutsumi T, Tsunemitsu A, Sasaki N, Kunisawa S et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined how cirrhosis severity affects outcomes in adult patients undergoing hip fracture surgery in Japan. Using hospital records from 2010-2021, researchers compared mortality, hospital stay length, and complications across different cirrhosis severity levels. The findings show that patients with more severe cirrhosis had significantly higher mortality rates and longer hospital stays.
Key points
- In-hospital mortality increased with cirrhosis severity: 1.5% (Class A) vs 5.9% (Class B) vs 28.4% (Class C)
- No difference in mortality between non-cirrhosis patients and those with mild cirrhosis (Class A)
- Patients with severe cirrhosis had longer hospital stays and higher hospitalization fees
- Study included 833,648 eligible hip fracture patients using propensity-score matching
- Results suggest need for careful risk-benefit discussions for patients with severe cirrhosis
Limitations
This study focuses on adult patients with hip fractures and cirrhosis, not on children's well-being. The findings apply to older populations and cannot inform policy or practice regarding child health outcomes.
Abstract
Background Advanced cirrhosis is associated with increased mortality in certain surgeries, but the impact of cirrhosis severity on outcomes in patients with hip fractures remains unclear. Methods In a large nationwide administrative database of hospitalized patients, we compared postoperative outcomes in patients with hip fractures across different Child-Pugh classes of cirrhosis in Japan. Using the Japanese Diagnosis Procedure Combination Database, we identified 833,648 eligible patients diagnosed with hip fractures and underwent surgery between July 2010 and March 2021. Three sets of 1:1 propensity-score matching were performed for four groups: non-cirrhosis cases and Child-Pugh classes A, B, and C. We compared in-hospital mortality, length of stay, hospitalization fees, readmission, and complications in non-cirrhosis cases vs. Child-Pugh class A, Child-Pugh class A vs. B, and Child-Pugh class B vs. C. Results Propensity-score matching created 1065 pairs for non-cirrhosis vs. Child-Pugh class A, 1012 for Child-Pugh class A vs. B, and 489 for Child-Pugh class B vs. C. In-hospital mortality did not differ between non-cirrhosis cases and those with Child-Pugh class A. However, in-hospital mortality was significantly higher in patients with Child-Pugh class B than in those with class A (1.5 % vs. 5.9 %; RD 4.45 %; 95 % CI: 2.79%-6.10 %), and higher in patients with Child-Pugh class C compared with class B (6.3 % vs. 28.4 %; RD 22.09 %; 95 % CI: 17.54%-26.63 %). Patients in more severe Child-Pugh classes had longer hospital stays, higher hospitalization fees, and higher complication rates. Conclusion Patients with hip fractures and cirrhosis who are at high risk of poor postoperative outcomes could be identified. This study highlights the significantly higher in-hospital mortality observed in patients with Child-Pugh class C cirrhosis undergoing hip fracture surgery compared to those with class B. These findings underscore the need for careful risk-benefit discussions, considering the severity of cirrhosis, surgical risks, and care goals for each patient.