The effect of chronic liver disease on acute outcomes following cervical spine trauma

Abstract Background The adverse impact of chronic liver disease, including chronic hepatitis and cirrhosis, on outcomes following orthopaedic surgery has been increasingly recognized in recent years. The impact of these conditions on acute outcomes following spinal trauma remain unknown. Study Design Cohort control study using patient records in the Massachusetts Statewide Inpatient Dataset (2003-2010). Purpose To evaluate whether chronic liver disease increased the odds of mortality, complications, failure to rescue (FTR), reoperation and hospital length of stay following cervical spine trauma. Sample 10,841 patients with cervical spine trauma. Outcomes Post-treatment morbidity, mortality, reoperation and LOS. Methods Differences between patients with and without chronic liver disease were evaluated using chi-square or Wilcoxon rank sum tests. Logistic and negative binomial regression techniques were used to adjust for confounders, including whether a surgical intervention was performed. Receiver operator characteristic curves were used to assess final model discrimination. Results There were 117 patients with chronic liver disease identified in the cohort. The rate of surgical intervention for cervical trauma was not significantly different between patients with and without chronic liver disease [OR 0.82 (95% CI 0.52-1.29)]. Mortality (OR 2.12, 95% CI 1.23-3.66), FTR (OR 2.86; 95% CI 1.34, 6.11), complications (OR 1.65, 95% CI 1.12-2.45), and LOS (RC 0.31, 95% CI 0.14, 0.48), were all significantly increased for patients with chronic liver disease in final adjusted models that controlled for differences in case-mix and whether a surgical procedure was performed. Final models explained approximately 72% of the variation in mortality and FTR. Conclusions Our novel findings indicate that patients with chronic liver disease may be at elevated risk of post-treatment morbidity and mortality following cervical spine trauma. Medical co-management in the acute period following injury and optimization prior to surgery may diminish the potential for adverse events.