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. 2023 Oct 20;7(2):160-168.
doi: 10.1093/jcag/gwad040. eCollection 2024 Apr.

Emergency Colorectal Surgery in Those with Cirrhosis: A Population-based Study Assessing Practice Patterns, Outcomes and Predictors of Mortality

Lisa Zhang  1 , Kelly Brennan  2 , Jennifer A Flemming  2 , Sulaiman Nanji  2 , Maya Djerboua  2 , Shaila J Merchant  2 , Antonio Caycedo-Marulanda  3 , Sunil V Patel  2
Affiliations

Emergency Colorectal Surgery in Those with Cirrhosis: A Population-based Study Assessing Practice Patterns, Outcomes and Predictors of Mortality

Lisa Zhang et al. J Can Assoc Gastroenterol. .

Abstract

Background: Those with cirrhosis who require emergency colorectal surgery are at risk for poor outcomes. Although risk predictions models exists, these tools are not specific to colorectal surgery, nor were they developed in a contemporary setting. Thus, the objective of this study was to assess the outcomes in this population and determine whether cirrhosis etiology and/or the Model for End Stage Liver Disease (MELD-Na) is associated with mortality.

Methods: This population-based study included those with cirrhosis undergoing emergent colorectal surgery between 2009 and 2017. All eligible individuals in Ontario were identified using administrative databases. The primary outcome was 90-day mortality.

Results: Nine hundred and twenty-seven individuals (57%) (male) were included. The most common cirrhosis etiology was non-alcoholic fatty liver disease (NAFLD) (50%) and alcohol related (32%). Overall 90-day mortality was 32%. Multivariable survival analysis demonstrated those with alcohol-related disease were at increased risk of 90-day mortality (hazards ratio [HR] 1.53, 95% confidence interval [CI] 1.2-2.0 vs. NAFLD [ref]). Surgery for colorectal cancer was associated with better survival (HR 0.27, 95%CI 0.16-0.47). In the subgroup analysis of those with an available MELD-Na score (n = 348/927, 38%), there was a strong association between increasing MELD-Na and mortality (score 20+ HR 6.6, 95%CI 3.9-10.9; score 10-19 HR 1.8, 95%CI 1.1-3.0; score <10 [ref]).

Conclusion: Individuals with cirrhosis who require emergent colorectal surgery have a high risk of postoperative complications, including mortality. Increasing MELD-Na score is associated with mortality and can be used to risk stratify individuals.

Keywords: cirrhosis; colorectal surgery; emergency surgery; mortality; risk stratification.

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Conflict of interest statement

The authors have no relevant financial disclosures or conflicts of interest.

Figures

Figure 1.
Figure 1.
Flowsheet of included individuals.
Figure 2.
Figure 2.
Kaplan Meier Survival analysis by MELD-Na (model for end-stage liver disease).
See this image and copyright information in PMC

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