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The impact of hepatitis C status on postoperative outcome
Ramsey C Cheung1, Frank Hsieh, Yajie Wang
1*Division of Gastroenterology and Hepatology, †Cooperative Studies Program Coordinating Center, and ‡Department of Anesthesia, VA Palo Alto Health Care System; and §Stanford University, California.
Insights
Hepatitis C virus (HCV) infection did not increase postoperative complications in surgical patients. Other factors like surgery urgency and patient health status were more significant risk factors.
Area of Science:
- Hepatology
- Surgical Outcomes
- Infectious Diseases
Background:
- The impact of hepatitis C virus (HCV) infection on surgical outcomes remains unclear.
- Understanding risk factors for postoperative complications is crucial for patient management.
Purpose of the Study:
- To investigate the association between hepatitis C virus antibody (anti-HCV) positivity and postoperative complications and mortality.
- To identify independent risk factors for surgical complications.
Main Methods:
- Retrospective analysis of 2457 surgical patients with measured anti-HCV status.
- Comparison of complication and mortality rates between anti-HCV positive and negative groups.
- Multivariate analysis to identify independent predictors of complications.
Main Results:
- Complication rates were similar between anti-HCV positive (10%) and negative (13%) groups (P=0.125).
- Mortality rates were lower in anti-HCV positive patients (0.7%) compared to negative patients (2.5%) (P=0.017).
- Urgency of surgery, age, ASA status, surgery length, and hematocrit were independent risk factors for complications, not anti-HCV status.
Conclusions:
- Hepatitis C virus infection is not an independent risk factor for postoperative complications.
- Surgery urgency, patient age, ASA physical status, surgery duration, and preoperative hematocrit are significant independent risk factors for postoperative complications.
Unlabelled:
The impact of the hepatitis C virus (HCV) infection on the postoperative complication rate is unknown. We identified a population of surgical patients (n = 2457) for whom the HCV antibody (anti-HCV) had been measured and compared after surgical complications and mortality between those who were positive (17.9%) versus negative. The complication rates were 10% in the anti-HCV positive and 13% in the negative group (P = 0.125), whereas the mortality rates were 0.7% and 2.5%, respectively (P = 0.017). The anti-HCV positive patients were younger, had lower ASA physical status, and underwent shorter procedures. In the univariate analysis, emergent surgery and high ASA physical status but not anti-HCV positivity were associated with a more frequent complication. In the multivariate analysis, the urgency of surgery, age, ASA physical status, length of surgery, and preoperative hematocrit (but not platelet count) were associated with complications. Anti-HCV positivity was associated with an odds ratio for having a complication of 1.08 (95% confidence interval, 0.90-1.30), which was not statistically significant (P = 0.405). In conclusion, we were unable to show HCV antibody status to be an independent risk factor for postoperative complications when other co-factors were considered.
Implications:
In this large study at a Veterans Administration medical center, the urgency of surgery, age, ASA physical status, length of surgery, and preoperative hematocrit were all independently associated with postoperative complications. However, hepatitis C infection was not an independent risk factor for postoperative complications.
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