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The impact of hepatitis C virus infection on 90-day outcomes following major orthopaedic surgery: a propensity-matched analysis

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

The impact of hepatitis C virus (HCV) infection on outcomes following major orthopaedic interventions, such as joint arthroplasty or spine surgery, has not been effectively studied in the past. Most prior studies are impaired by small samples, limited surveillance for adverse events, or the potential for selection bias to confound results. In this context, we sought to evaluate the impact of HCV infection on 90-day outcomes following joint arthroplasty or spine surgery using propensity-matched techniques.

Materials and methods

This study utilized 2006–2014 claims from TRICARE insurance. Adults who received spine surgical procedures, total knee and hip arthroplasty were identified. Covariates included demographic factors, a diagnosis of HCV and medical co-morbidities defined by International Classification of Disease-9th revision (ICD-9) code. Outcomes consisted of 30- and 90-day mortality, complications and readmission. A propensity score was used to balance the cohorts with logistic regression techniques employed to determine the influence of HCV infection on post-operative outcomes.

Results

The propensity-matched cohort consisted of 2262 patients (1131 with and without HCV). Following logistic regression, patients with HCV were found to have increased odds of 30-day complications (OR 1.87; 95% CI 1.33, 2.64; p < 0.001), 90-day complications (OR 1.55; 95% CI 1.16, 2.08; p = 0.003) and 30-day readmission (OR 1.46; 95% CI 1.04, 2.05; p = 0.03).

Conclusion

HCV infection was found to increase the risk of complication and readmission following spine surgery and total joint arthroplasty. Patients should be counseled on their increased risk prior to surgery. Health systems that treat a higher percentage of patients with HCV need to consider the increased risk of complications and readmission when negotiating with insurance carriers.

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Authors and Affiliations

  1. Department of Surgery, Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA

    Ritam Chowdhury, Muhammad Ali Chaudhary, Daniel J. Sturgeon, Wei Jiang & Adil H. Haider

  2. Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA, 02111, USA

    Allan L. Yau

  3. Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA

    Tracey P. Koehlmoos

  4. Department of Orthopaedic Surgery, Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA

    Andrew J. Schoenfeld

Authors
  1. Ritam Chowdhury
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  2. Muhammad Ali Chaudhary
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  3. Daniel J. Sturgeon
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  4. Wei Jiang
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  5. Allan L. Yau
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  6. Tracey P. Koehlmoos
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  7. Adil H. Haider
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  8. Andrew J. Schoenfeld
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Corresponding author

Correspondence to Andrew J. Schoenfeld.

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Conflict of interest

The authors declare that they have no conflict of interest.

Funding

This study was supported by a grant from the Henry M. Jackson Foundation of the Department of Defense.

Ethical approval

This research was approved by our institutional review board prior to commencement.

Informed consent

Need for informed consent was waived by our institutional review board given the design of this study.

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Chowdhury, R., Chaudhary, M.A., Sturgeon, D.J. et al. The impact of hepatitis C virus infection on 90-day outcomes following major orthopaedic surgery: a propensity-matched analysis. Arch Orthop Trauma Surg 137, 1181–1186 (2017). https://doi.org/10.1007/s00402-017-2742-7

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  • DOI: https://doi.org/10.1007/s00402-017-2742-7

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