Thirty-day case fatality after nephrectomy in patients with liver cirrhosis--a Danish population-based cohort study

Previous studies have shown that patients with liver cirrhosis are at increased risk of death after a number of surgical procedures, but their risk of death after nephrectomy has not been examined. We compared the 30-day postoperative case fatality rate after nephrectomy in patients with liver cirrhosis with that of patients without liver cirrhosis using data from an established dataset.

Between 1 January, 1977 and 31 December, 1993 we followed a population-based cohort of Danish liver cirrhosis patients in order to identify those who underwent nephrectomy. A control group of patients without liver cirrhosis who underwent nephrectomy during the same period was also identified. A logistic regression model was used to estimate the odds ratio of the 30-day case fatality rate of patients with liver cirrhosis relative to those without liver cirrhosis. The model was adjusted for age, sex, comorbidity and type of admission. The study was based entirely on data from the Danish National Registry of Patients.

A total of 29/23 133 patients with liver cirrhosis underwent nephrectomy, and the control group comprised 582 patients without liver cirrhosis. The 30-day case fatality rates were 24.1% and 8.1%, respectively, yielding an adjusted odds ratio of 3.6 (95% CI 1.2-8.9) for patients with liver cirrhosis relative to those without liver cirrhosis. Male gender, high comorbidity and emergency admission were also associated with an increased risk of postoperative death.

Nephrectomy in patients with liver cirrhosis carries an increased risk of postoperative death, but the lack of clinical data prevents us from suggesting guidelines for clinical management.