Abdominal operations in patients with cirrhosis: Still a major surgical challenge

doi:10.1016/S0039-6060(97)90080-5

Surgery

Volume 122, Issue 4, October 1997, Pages 730-736

https://doi.org/10.1016/S0039-6060(97)90080-5 Get rights and content

Abstract

Background. Hepatic transplantation and portasystemic shunts can be safely performed in patients with advanced liver disease, whereas other abdominal procedures appear to have a much higher mortality rate. This study reviews the outcomes of patients with cirrhosis after the full spectrum of abdominal operations.

Methods. In a 12-year period, 92 patients diagnosed with cirrhosis required either an emergent or elective abdominal operation. There were four categories of operations: cholecystectomy in 17 patients, hernia in 9, gastrointestinal tract in 54, and other procedures in 12. Fifty-five clinical, laboratory, and operative variables were analyzed to identify factors predictive of poor outcome.

Results. Coagulopathy developed in 24 patients (27%) and sepsis in 15 (16%). The mortality rate after emergent operations was 50%, compared to 18% for elective cases (p = 0.001). Other factors that predicted mortality included the presence of ascites (p = 0.006), encephalopathy (p = 0.002), and elevated prothrombin time (p = 0.021). The mortality in Child's class A patients was 10%, compared to 30% in class B and 82% in class C patients.

Conclusions. Patients with cirrhosis undergoing elective or emergent operations are at a significant risk of developing postoperative complications leading to death. The most accurate predictor of outcome is the patient's preoperative Child's class.

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^☆: Presented at the Fifty-fourth Annual Meeting of the Central Surgical Association, Chicago, Ill., March 7–9, 1997.

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Abdominal operations in patients with cirrhosis: Still a major surgical challenge☆

Abstract

Am J Surg

Am J Surg

Am J Surg

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Ann Surg

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Ann Surg

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Surgery

Is portal-systemic shunt worthwhile in Child's C cirrhosis?

Ann Surg

Clarification of risk factors for abdominal operations in patients with hepatic cirrhosis

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