The risk of perioperative adverse events in patients with chronic liver disease

Chronic liver disease is a common comorbidity in surgery. To assess post-operative morbidity and mortality in relation to progression of chronic liver disease and to identify the risk factors.

Six hundred and nine consecutive patients with chronic liver disease who underwent surgery were classified into two groups: non-cirrhotic (n = 363) and cirrhotic (n = 246). Randomly selected patients without underlying liver disease who underwent surgery were used as control group (n = 148).

The occurrence of major post-operative complications was higher in the non-cirrhotic group than in the control group (11.8% vs. 6.1%, P = 0.051); age, type of surgery and serum albumin level were independent predictors for post-operative morbidity. The frequency of significant post-operative liver damage (14.9% vs. 12.2%, P = 0.920) and mortality (0.6% vs. 0.7%, P = 0.871) did not differ between the two groups. The cirrhotic group had markedly higher incidences of post-operative mortality (10.2%), major complications (32.5%) and significant liver damage (43.1%) than the control and non-cirrhotic groups (all P < 0.001). Type of surgery, Child-Pugh score and model for end-stage liver disease score were independently associated with post-operative morbidity and mortality in patients with cirrhosis. Specific data regarding post-operative morbidity and mortality were presented according to progression of liver disease and type of surgery.

Non-cirrhotic chronic liver diseases were associated with higher risk of post-operative morbidity, particularly in cases of major surgery, older age and hypoalbuminaemia. Cirrhosis further increased the risk, even death, depending on degree of hepatic decompensation and type of surgery.