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©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
Safety and outcomes of hip and knee replacement surgery in liver transplant recipients
Mohamed Ahmed, Abdelrhman Abumoawad, Fouad Jaber, Hebatullah Elsafy, Saqr Alsakarneh, Laith Al Momani, Alisa Likhitsup, John H Helzberg
Mohamed Ahmed, Fouad Jaber, Saqr Alsakarneh, Department of Internal Medicine, University of Missouri Kansas City, Kansas City, MO 64108, United States
Abdelrhman Abumoawad, Department of Vascular Medicine, Boston University, Boston, MA 02215, United States
Hebatullah Elsafy, Department of Pathology, Kansas University, Kansas City, MO 66160, United States
Laith Al Momani, John H Helzberg, Department of Gastroenterology, University of Missouri Kansas City, Kansas City, MO 64110, United States
Alisa Likhitsup, Department of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI 48109, United States
Author contributions: Ahmed M contributed to the conception and literature review of the manuscript; Ahmed M, Abumoawad A, and Elsafy H designed this study; Ahmed M and Jaber F drafted the manuscript; Abumoawad A collected the data; Jaber F, Al Momani L, Likhitsup A, and Helzberg JH involved in the critical reviewing of the manuscript; Elsafy H contributed to the analytic plan; Helzberg JH supervised and edited the manuscript.
Institutional review board statement: This study is performed based on the Healthcare Cost and Utilization Project databases. The HIPAA Privacy Rule sets national standards for patient rights with respect to health information. This rule protects individually identifiable health information by establishing conditions for its use and disclosure by covered entities.
Informed consent statement: This study is performed based on the Healthcare Cost and Utilization Project databases. The HIPAA Privacy Rule sets national standards for patient rights with respect to health information. This rule protects individually identifiable health information by establishing conditions for its use and disclosure by covered entities.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: This study is performed based on the Healthcare Cost and Utilization Project databases.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Mohamed Ahmed, MD, MSc, Doctor, Department of Internal Medicine, University of Missouri Kansas City, 2301 Holmes Street, Kansas City, MO 64108, United States. mohamedfayez1991@gmail.com
Received: July 15, 2023
Peer-review started: July 15, 2023
First decision: August 14, 2023
Revised: September 13, 2023
Accepted: October 23, 2023
Article in press: October 23, 2023
Published online: November 18, 2023
BACKGROUND
Liver transplant (LT) is becoming increasingly common with improved life expectancy. Joint replacement is usually a safe procedure; however, its safety in LT recipients remains understudied.
AIM
To evaluate the mortality, outcome, and 90-d readmission rate in LT patients undergoing hip and knee replacement surgery.
METHODS
Patients with history of LT who underwent hip and knee replacement surgery between 2016 and 2019 were identified using the National Readmission Database.
RESULTS
A total of 5046119 hip and knee replacement surgeries were identified. 3219 patients had prior LT. Mean age of patients with no history of LT was 67.51 [95% confidence interval (CI): 67.44-67.58], while it was 64.05 (95%CI: 63.55-64.54) in patients with LT. Patients with history of LT were more likely to have prolonged length of hospital stay (17.1% vs 8.4%, P < 0.001). The mortality rate for patients with no history of LT was 0.22%, while it was 0.24% for patients with LT (P = 0.792). Patients with history of LT were more likely to have re-admissions within 90 d of initial hospitalization: 11.4% as compared to 6.2% in patients without history of LT (P < 0.001). The mortality rate between both groups during readmission was not statistically different (1.9% vs 2%, P = 0.871) respectively.
CONCLUSION
Hip and knee replacements in patients with history of LT are not associated with increased mortality; increased re-admissions were more frequent in this cohort of patients. Chronic kidney disease and congestive heart failure appear to predict higher risk of readmission.
Core Tip: Patients receiving liver transplants (LTs) are having longer life expectancy. This resulted in an increasing number of patients with LTs requiring hip and knee surgery, with data about their outcomes being limited. The aim of this analysis is to evaluate the safety of these procedures in LT patients and provide more guidance on expected outcomes. This study concluded that LT patients are not at risk of higher mortality albeit increased morbidity.
