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. 2021 Oct 1;274(4):e345-e354.
doi: 10.1097/SLA.0000000000003674.

Incidence and Risk Factors of Postoperative Mortality and Morbidity After Elective Versus Emergent Abdominal Surgery in a National Sample of 8193 Patients With Cirrhosis

Kay M Johnson  1   2 , Kira L Newman  3 , Pamela K Green  4 , Kristin Berry  4 , Paul B Cornia  1   2 , Peter Wu  5 , Lauren A Beste  2   4   6 , Kamal Itani  7 , Alex H S Harris  8   9 , Patrick S Kamath  10 , George N Ioannou  4   11
Affiliations

Incidence and Risk Factors of Postoperative Mortality and Morbidity After Elective Versus Emergent Abdominal Surgery in a National Sample of 8193 Patients With Cirrhosis

Kay M Johnson et al. Ann Surg. .

Abstract

Objective: To describe the incidence and risk factors for mortality and morbidity in patients with cirrhosis undergoing elective or emergent abdominal surgeries.

Background: Postoperative morbidity and mortality are higher in patients with cirrhosis; variation by surgical procedure type and cirrhosis severity remain unclear.

Methods: We analyzed prospectively-collected data from the Veterans Affairs (VA) Surgical Quality Improvement Program for 8193 patients with cirrhosis, 864 noncirrhotic controls with chronic hepatitis B infection, and 5468 noncirrhotic controls without chronic liver disease, who underwent abdominal surgery from 2001 to 2017. Data were analyzed using random-effects models controlling for potential confounders.

Results: Patients with cirrhosis had significantly higher 30-day mortality than noncirrhotic patients with chronic hepatitis B [4.4% vs 1.3%, adjusted odds ratio (aOR) 2.80, 95% confidence interval (CI) 1.57-4.98] or with no chronic liver disease (0.8%, aOR 4.68, 95% CI 3.27-6.69); mortality difference was highest in patients with Model for End-stage Liver Disease (MELD) score ≥10. Among patients with cirrhosis, postoperative mortality was almost 6 times higher after emergent rather than elective surgery (17.2% vs. 2.1%, aOR 5.82, 95% CI 4.66-7.27). For elective surgeries, 30-day mortality was highest after colorectal resection (7.0%) and lowest after inguinal hernia repair (0.6%). Predictors of postoperative mortality included cirrhosis-related characteristics (high MELD score, low serum albumin, ascites, encephalopathy), surgery-related characteristics (emergent vs elective, type of surgery, intraoperative blood transfusion), comorbidities (chronic obstructive pulmonary disease, cancer, sepsis, ventilator dependence, functional status), and age.

Conclusions: Accurate preoperative risk assessments in patients with cirrhosis should account for cirrhosis severity, comorbidities, type of procedure, and whether the procedure is emergent versus elective.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

References

    1. Csikesz NG, Nguyen LN, Tseng JF, et al. Nationwide volume and mortality after elective surgery in cirrhotic patients. J Am Coll Surg 2009; 208:96–103.
    1. Nguyen GC, Correia AJ, Thuluvath PJ. The impact of cirrhosis and portal hypertension on mortality following colorectal surgery: a nationwide, population-based study. Dis Colon Rectum 2009; 52:1367–1374.
    1. Friedman LS. Surgery in the patient with liver disease. Trans Am Clin Climatol Assoc 2010; 121:192–204. [discussion 205].
    1. Im GY, Lubezky N, Facciuto ME, et al. Surgery in patients with portal hypertension: a preoperative checklist and strategies for attenuating risk. Clin Liver Dis 2014; 18:477–505.
    1. Cohen ME, Liu Y, Ko CY, et al. An examination of American College of Surgeons NSQIP surgical risk calculator accuracy. J Am Coll Surg 2017; 224:787–795.e1.

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