Childs-Pugh class B, C linked with higher mortality risk after TJA in patients with HCV
According to presented results, patients with hepatitis C who undergo total joint arthroplasty and are Childs-Pugh class B or C have increased 2-year mortality rates compared with patients who are Childs-Pugh class A.
“For general abdominal surgery, Childs-Pugh score is used to predict mortality for liver disease patients after surgery, with class A having a 10% mortality rate, B a 30% and C a 70% to 80% mortality rate,” Kyle H. Cichos, BS, said in his presentation at the Musculoskeletal Infection Society Annual Meeting. “So, we decided to ask what the risk factors were for early mortality in HCV patients undergoing elective arthroplasty,” he added.
Cichos and colleagues performed a retrospective analysis of data for 169 patients with HCV who underwent elective primary TJA from 2005 to 2019 with a minimum 2-year follow-up. Researchers compared outcomes between the 16 patients with early mortality and the 153 surviving patients. Cichos noted no differences between the groups regarding liver fibrosis stage or activity level, alanine transaminase, HCV genotype, viral load, HCV treatment, Model for End-Stage Liver Disease score, American Society of Anesthesiologists score, tranexamic acid use, anesthesia type, operative duration, blood loss, blood transfusion rate, ICU stay or comorbidities.
At the time of surgery, patients with HCV who were categorized as Childs-Pugh class B or C had an independently increased risk of 2-year mortality (odds ratio = 29.24) compared with patients who were class A.
“Surgeons should counsel these patients preoperatively of this increased risk and consider the risk [vs.] reward of elective surgery,” Cichos said. “It might be best to just manage [class C patients] nonoperatively going forward given this risk.”
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Cichos KH, et al. Paper 1022. Presented at: Musculoskeletal Infection Society Annual Meeting; Aug. 5-6, 2022; Pittsburgh (hybrid meeting).
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