Background
Patients with liver cirrhosis have an increased risk of postoperative mortality. In
addition, cirrhotic patients per se have a reduced life expectancy. Little is known
about the combined effect of these factors on long-term outcomes after surgery. We
thus evaluated early -and long-term survival in patients with cirrhosis who underwent
abdominal surgery.
Methods
We evaluated 30- and 90-day mortality as well as long-term survival after 212 general
surgical procedures performed in 194 patients with liver cirrhosis. Risk factors for
early and late mortality were assessed by uni- and multivariate methods. To avoid
multicollinearity of data, different models (Child Turcotte Pugh [CTP], model for
end-stage liver disease [MELD], or American Society of Anesthesiologists [ASA] score)
were used in multivariate analysis.
Results
The 30- and 90-day mortality rates were 20% and 30%, respectively. CTP, MELD, and
ASA were all independently associated with 30- and 90-day mortality. Although emergency
operations and intraoperative transfusions independently influenced 30-day mortality,
90-day mortality also was influenced by the extent of the procedure and thrombocytopenia.
Survival after surgery (n = 180) was 54% after one and 25% after 5 years (median survival 1.24 years). Long-term
survival was independently influenced by CTP, MELD, ASA, hyponatremia, emergency operations,
thrombocytopenia, and underlying malignancies. Survival in patients discharged after
surgery (n = 140) was 69% after 1 and 33% after 5 years (median survival 2.8 years). Survival
after discharge was independently influenced by MELD, CTP, hyponatremia, underlying
malignant disease, and (partially) by serum creatinine. The inclusion of serum sodium
into MELD scores did not further facilitate prediction of early and late mortality.
Conclusion
A high postoperative mortality as well as a strongly reduced survival even after hospital
discharge contribute to the very poor life expectancy in patients with liver cirrhosis
requiring general surgery. Postoperative outcome is influenced by liver function,
comorbidity and “surgical” factors such as the need for blood transfusion and emergent
or major operations. However, after hospital discharge, “surgical” factors did not
influence survival.
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Article info
Publication history
Published online: November 25, 2013
Accepted:
November 15,
2013
Identification
Copyright
© 2013 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
