Factors that predict outcome of abdominal operations in patients with advanced cirrhosis
Dana A Telem1, Thomas Schiano, Robert Goldstone
1Division of General Surgery, Department of Surgery, The Mount Sinai Hospital, New York, New York, USA.
Insights
Cirrhotic patients face surgical risks, but preoperative albumin levels can guide operative decisions for those with high MELD scores. Limiting intraoperative blood transfusions also improves outcomes in these vulnerable patients.
Area of Science:
- Hepatology
- Surgical Oncology
- Anesthesiology
Background:
- Cirrhosis increases surgical complication risk, varying with liver disease severity.
- Selecting optimal surgical candidates with cirrhosis presents a clinical challenge.
- Identifying predictive factors for surgical outcomes in cirrhotic patients is crucial for management.
Purpose of the Study:
- To identify factors aiding the selection of surgical candidates with cirrhosis.
- To guide the perioperative management of cirrhotic patients undergoing surgery.
- To determine predictors of adverse outcomes in cirrhotic patients undergoing abdominal surgery.
Main Methods:
- Retrospective review of 100 cirrhotic patients (Child-Turcotte-Pugh A, B, C) undergoing abdominal surgery.
- Analysis of patient data from 2002-2008 at a liver medicine and transplant institution.
- Multivariate logistic regression to identify factors correlating with surgical outcomes.
Main Results:
- Overall 30-day postoperative mortality was 7%, with higher rates for advanced cirrhosis (CTP B/C) and MELD score ≥15.
- Risk factors for adverse outcomes included high ASA score, emergent procedures, significant blood loss/transfusion, ascites, high bilirubin, and low albumin.
- Adding serum albumin to the MELD score significantly stratified mortality risk for patients with MELD ≥15.
Conclusions:
- Preoperative albumin levels can refine risk assessment for cirrhotic patients with MELD scores ≥15.
- Limiting intraoperative packed red blood cell transfusions is recommended to improve outcomes.
- These findings can aid in operative decision-making and patient management for cirrhotic individuals.
Background & Aims:
Patients with cirrhosis have an increased risk of complications during surgery that is relative to the severity of liver disease; it is a challenge to determine which patients are the best candidates for surgery. We performed a hospital-based study to identify factors that might facilitate selection of operative candidates and guide their management.
Methods:
A retrospective review was performed of 100 cirrhotic patients (50 classified as Child-Turcotte-Pugh [CTP] A, 33 as CTP B, and 17 as CTP C) who underwent abdominal surgery at an institution specializing in liver medicine and transplant from 2002-2008. Significant univariate variables were evaluated by multivariate logistic regression models to identify factors that correlate with outcome.
Results:
The overall, 30-day postoperative mortality rate was 7%. The mortality for patients who were CTP A was 2%, CTP B was 12%, and CTP C was 12%; 33 patients had a Model for End-Stage Liver Disease (MELD) score >or=15, with 29% mortality. On the basis of multivariate analyses, risk factors for adverse outcome were American Society of Anesthesiologists (ASA) score >3; procedures being emergent; intraoperative blood transfusion; intraoperative blood loss >150 mL; presence of ascites; total bilirubin level >1.5 mg/dL; and albumin level <3 mg/dL. Addition of serum albumin to MELD score showed that patients with MELD score >or=15 and albumin
Conclusions:
For patients with MELD scores >or=15, the preoperative albumin level correlates with outcome and could guide operative decisions. Intraoperative packed red blood cell transfusion correlates with adverse outcome and should be limited.
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