Author:
McLellan M. A.,Donnelly M. R.,Callan K. T.,Lung B. E.,Liu S.,DiGiovanni R.,McMaster W. C.,Stitzlein R. N.,Yang S.
Abstract
Abstract
Background
The purpose of this study was to investigate the relationship between preoperative aspartate aminotransferase-to-platelet ratio index (APRI) and postoperative complications following total hip arthroplasty (THA).
Methods
All THA for osteoarthritis patients from 2007 to 2020 within the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database were included in this study. Subjects were subsequently divided into cohorts based on APRI. Four groups, including normal range, some liver damage, significant fibrosis, and cirrhosis groups, were created. Comparisons between groups were made for demographics, past medical history, and rate of major and minor complications. Other outcomes included readmission, reoperation, discharge destination, mortality, periprosthetic fracture, and postoperative hip dislocation. Multivariate logistic regression analysis was performed to determine the role of preoperative APRI in predicting adverse outcomes. Statistical significance was set at p < 0.05.
Results
In total, 104,633 primary THA patients were included in this study. Of these, 103,678 (99.1%) were in the normal APRI group, 444 (0.4%) had some liver damage, 256 (0.2%) had significant fibrosis, and 253 (0.2%) had cirrhosis. When controlling for demographics and relevant past medical history, the abnormal APRI groups had a significantly higher likelihood of major complication, minor complication, intraoperative or postoperative bleeding requiring transfusion, readmission, and non-home discharge (all p < 0.05) compared to normal APRI individuals.
Conclusions
Abnormal preoperative APRI is linked with an increasing number of adverse outcomes following THA for osteoarthritis for patients across the United States.
Level of evidence
Level I
Publisher
Springer Science and Business Media LLC
Subject
Orthopedics and Sports Medicine,Rheumatology
Reference28 articles.
1. Yan L, Ge L, Dong S, Saluja K, Li D, Reddy S, Wang Q, Yao L, Li JJ, da RozaCosta B, Xing D, Wang B. Evaluation of comparative efficacy and safety of surgical approaches for total hip arthroplasty: a systematic review and network meta-analysis. JAMA Network Open. 2023;6(1):e2253942.
2. Kremers HM, Larson DR, Crowson CS, Kremers WK, Washington RE, Steiner CA, Jiranek WA, Berry DJ. Prevalence of total hip and knee replacement in the United States. J Bone Jt Surg. 2015;97(17):1386-1397.
3. Schichman I, Roof M, Askew N, Nherera L, Rozell JC, Seyler TM, Schwarzkopf R. Projections and epidemiology of primary hip and knee arthroplasty in Medicare patients to 2040–2060. JBJS Open Access. 2023;8:e22.00112.
4. Zalikha AK, Pham L, Keeley J, Hussein IH, El-Othmani MM. Frailty among total hip and knee arthroplasty recipients: epidemiology and propensity score-weighted analysis of effect on in-hospital postoperative outcomes. J Am Acad Orthop Surg. 2023;31(^):292–9.
5. Yilmaz Y, Yonal O, Kurt R, Bayrak M, Aktas B, Ozdogan O. Noninvasive assessment of liver fibrosis with the aspartate transaminase to platelet ratio index (APRI): usefulness in patients with chronic liver disease: APRI in chronic liver disease. Hepat Mon. 2011;11(2):103–6.