Cirrhosis is independently associated with complications and mortality following operative treatment of acetabular fractures

Julian R Wier; Reza Firoozabadi; Joseph T Patterson

doi:10.1016/j.injury.2023.02.038

Cirrhosis is independently associated with complications and mortality following operative treatment of acetabular fractures

Injury. 2023 Feb 22:S0020-1383(23)00171-7. doi: 10.1016/j.injury.2023.02.038. Online ahead of print.

Authors

Julian R Wier¹, Reza Firoozabadi², Joseph T Patterson³

Affiliations

¹ Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
² Department of Orthopedics and Sports Medicine, University of Washington, Seattle, WA, USA.
³ Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA. Electronic address: josephp7@usc.edu.

PMID: 36878732
DOI: 10.1016/j.injury.2023.02.038

Abstract

Introduction: Patients with cirrhosis are at higher risk for morbidity after injury. Acetabular fractures represent a highly morbid injury pattern. Few studies have specifically examined an effect of cirrhosis on risk of complications after acetabular fracture. We hypothesized that cirrhosis is independently associated with increased risk of inpatient complications following operative treatment of acetabular fractures.

Methods: Adults patients with acetabular fracture who underwent operative treatment were identified from Trauma Quality Improvement Program data from 2015 to 2019. Patients with and without cirrhosis were matched on a propensity score predicting cirrhotic status and inpatient complications based on patient, injury, and treatment characteristics. The primary outcome was overall complication rate. Secondary outcomes included serious adverse event rate, overall infection rate, and mortality.

Results: After propensity score matching, 137 cirrhosis+ and 274 cirrhosis- remained. No significant differences existed in observed characteristics after matching. Compared to cirrhosis- patients, cirrhosis+ patients experienced 43.4% (83.9 vs 40.5%, p < 0.001) greater absolute risk difference of any inpatient complication, 29.9% (51.8 vs 21.9%, p < 0.001) greater absolute risk difference of serious adverse events, 28.5% (41.6 vs 13.1%, p < 0.001) greater absolute risk difference of any infection, and 2.9% (2.9% vs 0.0%, p = 0.02) greater absolute risk difference of inpatient mortality.

Conclusion: Cirrhosis is associated with higher rates of inpatient complications, serious adverse events, infection, and mortality among patients undergoing operative repair of acetabular fracture.

Level of evidence: Prognostic Level III.

Keywords: Acetabulum; Cirrhosis; Complications; Fracture; Infection; Mortality.