Postoperative complication risk following carpometacarpal arthroplasty in patients with non-alcoholic fatty liver disease versus non-alcoholic cirrhosis: A matched cohort study

Introduction: As the prevalence of metabolic dysfunction–associated steatotic liver disease (MASLD), formerly NAFLD, continues to rise, increasing numbers of patients with hepatic dysfunction are undergoing elective orthopedic procedures. While cirrhosis has been linked to poor outcomes after major surgery, its impact on minor hand procedures such as carpometacarpal (CMC) arthroplasty remains unclear. Methods: This retrospective matched cohort study utilized the PearlDiver Mariner M170Ortho database (2010–2021) to compare outcomes following CMC arthroplasty in patients with non-alcoholic cirrhosis versus those with NAFLD. From an initial pool of 181,241 patients undergoing CMC arthroplasty, 1,052 with cirrhosis and 3,078 with NAFLD were identified, and 824 patients (412 per group) were matched 1:1 based on age, sex, Charlson Comorbidity Index, and key comorbidities. Patients were 1:1 matched based on age, sex, Charlson Comorbidity Index, and key comorbidities. Ninety-day and one-year postoperative complications, reoperations, and reimbursements were assessed using multivariable logistic regression adjusted for age, sex, and CCI. Results: The final matched cohort included 824 patients (412 per group). No significant differences in 90-day or one-year complication rates were observed between cirrhosis and NAFLD cohorts, including surgical site infection (1.7 % vs 2.4 % at 90 days, p = 1.0), UTI (4.9 % vs 5.6 %, p = 0.754), or readmission (1.0 % vs 1.7 %, p = 0.544). One-year outcomes were similarly equivalent, with no significant differences in infection, AKI, pneumonia, or composite complication rates. Reoperation rates were 0 % in both groups. Ninety-day reimbursements were not significantly different (mean $6,447 vs $5,832, p = 0.301). Conclusion: CMC arthroplasty demonstrated comparable short- and intermediate-term outcomes in patients with non-alcoholic cirrhosis and NAFLD. Despite greater baseline complexity, cirrhotic patients had similar outcomes, supporting the procedure's feasibility in appropriately selected individuals.