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Portal Hypertension: An Underestimated Entity?
Zakiyah Kadry1, Eric W Schaefer, Riaz Ali Shah
1*Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA †Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, PA ‡Division of Gastroenterology, College of Medicine, The Pennsylvania State University, Hershey, PA §Department of Medicine, The Pennsylvania State University, Hershey, PA ¶Department of Anesthesiology, College of Medicine, The Pennsylvania State University, Hershey, PA.
Annals of Surgery
|July 17, 2015
Summary
Portal hypertension significantly increases mortality and morbidity in general surgery. This risk is present even in patients with a Model for End Stage Liver Disease score of 15 or less, highlighting the need for careful assessment.
Area of Science:
- General Surgery
- Hepatology
- Clinical Risk Assessment
Background:
- Limited data exists on portal hypertension's impact on general surgical outcomes.
- Existing risk scores (Child-Pugh, MELD) do not fully capture portal hypertension severity.
- Research has primarily focused on portal hypertension in liver surgery.
Purpose of the Study:
- To evaluate portal hypertension as an independent risk factor in general surgical procedures.
- To assess the association between portal hypertension and 30-day mortality and morbidity.
- To determine if the Model for End Stage Liver Disease (MELD) score accurately reflects risk in portal hypertension patients undergoing general surgery.
Main Methods:
- Case-matched cohort study using the National Surgical Quality Improvement Program (NSQIP) database (2005-2012).
- Patients with esophageal varices (portal hypertension cohort) were matched 1:2 with patients without esophageal varices (NEV) by demographics, surgery type, and year.
- Generalized estimating equations were used to analyze 30-day mortality and morbidity. MELD scores were used for subgroup analysis.
Main Results:
- A cohort of 1,574 esophageal varices (EV) patients was matched with 3,148 NEV patients.
- EV patients demonstrated a 3.01-fold increased odds of 30-day mortality (P < 0.001) and 1.28-fold increased odds of complications (P < 0.001) versus NEV patients.
- EV patients with MELD >15 had significantly higher mortality (4.64-fold) and morbidity (1.75-fold) risks, while those with MELD ≤15 still showed increased mortality (1.95-fold) and morbidity risks.
Conclusions:
- Portal hypertension is a significant independent risk factor for mortality and morbidity in general surgery.
- The risk associated with portal hypertension should not be underestimated, even in patients with MELD scores of 15 or less.
- Current risk assessment tools may not adequately account for the impact of portal hypertension in non-liver specific general surgical contexts.
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