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The impact of cirrhosis in patients undergoing cardiac surgery: a retrospective observational cohort study
Sheela Xavier1, Colleen M Norris2, Amanda Ewasiuk1
1Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, T6G 2X8, Canada.
Insights
Patients with cirrhosis undergoing cardiac surgery face higher mortality and complication risks. This study highlights increased postoperative complications and resource needs in cirrhotic patients, emphasizing the impact of liver disease on surgical outcomes.
Area of Science:
- Cardiology
- Hepatology
- Transplantation
Background:
- Patients with cirrhosis and heart disease present a complex clinical challenge.
- Major cardiac surgery outcomes are significantly poorer in patients with cirrhosis.
Purpose of the Study:
- To investigate the association between cirrhosis severity and post-cardiac surgical outcomes.
- To evaluate the impact of cirrhosis on mortality, complications, and healthcare resource utilization after cardiac surgery.
Main Methods:
- A historical cohort analysis was conducted from January 2004 to December 2014.
- Sixty patients with cirrhosis were propensity score-matched to 310 patients without cirrhosis.
- Outcomes evaluated included mortality, postoperative complications, and healthcare resource requirements.
Main Results:
- Ten-year mortality was significantly higher in cirrhotic patients (40% vs. 20%).
- Cirrhotic patients experienced more complications (63% vs. 48%) and longer intensive care unit stays.
- Cirrhosis and intraoperative transfusion were independently associated with increased mortality.
Conclusions:
- Cirrhotic patients undergoing cardiac surgery have significantly higher mortality and require more organ support, even with low Model for End-Stage Liver Disease scores.
- Cirrhosis presence is an independent predictor of increased mortality post-cardiac surgery.
- These findings underscore the critical impact of liver disease on cardiac surgical outcomes.
Purpose:
Patients with cirrhosis and concomitant coronary/valvular heart disease present a clinical dilemma. The therapeutic outcome of major cardiac surgery is significantly poorer in patients with cirrhosis compared with patients without cirrhosis. To address this, we aimed to identify associations between the severity of cirrhosis and post-cardiac surgical outcomes.
Methods:
A historical cohort analysis of patients undergoing cardiac surgery at the University of Alberta Hospital from January 2004 to December 2014 was used to identify and propensity score-match 60 patients with cirrhosis to 310 patients without cirrhosis. The relationships between cirrhosis and i) mortality, ii) postoperative complications, and iii) requirement of healthcare resources were evaluated.
Results:
Ten-year mortality was significantly higher in cirrhotic patients compared with propensity score-matched non-cirrhotic patients (40% vs 20%; relative risk [RR], 2.0; 95% confidence interval [CI], 1.3 to 2.9; P = 0.001). Cirrhotic patients had more complications (63% vs 48%; RR, 1.3; 95% CI, 1.05 to 1.7; P = 0.02), longer median [interquartile range (IQR)] intensive care unit stays (5 [3-11] vs 2 [1-4] days; P < 0.001), time on mechanical ventilation (median [IQR] 2 [1-5] vs 1 [0.5-1.2] days; P < 0.001) and more frequently required renal replacement therapy (15% vs 6%; RR, 2.5; 95% CI, 1.2 to 5.2; P = 0.02) postoperatively. After adjusting for other covariates, presence of cirrhosis (adjusted odds ratio, 2.2; 95% CI, 1.1 to 4.1) and intraoperative transfusion (adjusted odds ratio, 3.2; 95% CI, 1.6 to 6.3) were independently associated with increased mortality.
Conclusion:
Despite having low median model for end-stage liver disease scores, this small series of cirrhotic patients undergoing cardiac surgery had significantly higher mortality rates and required more organ support postoperatively than propensity score-matched non-cirrhotic patients. Impact de la cirrhose chez les patients subissant une chirurgie cardiaque : une étude de cohorte observationnelle et rétrospective.
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