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NEW YORK (Reuters Health) Feb 06 - Patients with cirrhosis, even if it is not complicated by portal hypertension, have a high risk of death with common elective surgeries, researchers report in the January issue of the Journal of the American College of Surgeons.
Dr. Shimul A. Shah and colleagues at the University of Massachusetts Medical Center in Worcester used the Nationwide Inpatient Sample to identify all patients undergoing one of four elective surgeries: cholecystectomy, colectomy, abdominal aortic aneurysm repair, and coronary artery bypass grafting (CABG), between 1998 and 2005. In-hospital mortality was the primary endpoint.
About 2.8 million patients underwent one of the surgeries; 22,569 patients had cirrhosis, and 4,214 of them had portal hypertension.
Mortality rates increased with increasing severity of liver disease for each operation. Hazard ratios for mortality in patients with cirrhosis versus those without were 3.4 for cholecystectomy, 3.7 for colectomy, 5.0 for abdominal aneurysm repair, and 8.0 for CABG.
Corresponding hazard ratios for mortality in patients with cirrhosis and portal hypertension were 12.3, 14.3, 7.8 and 22.7.
Dr. Shah and colleagues say, "These values can be used as a frame of reference for the individual surgeon when considering different treatment options for patients with liver disease who may benefit from elective surgery, and for providing informed consent to these patients."
J Am Coll Surg 2009;208:96-103.
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