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Clinical Ascites and Emergency Procedure as Determinants of Surgical Risk in Patients with Advanced Chronic Liver

Lidia Canillas1,2,3, Amalia Pelegrina1,3,4, Fawaz Wasef León1,5

  • 1Department of Medicine and Life Sciences, Universitat Pompeu Fabra, 08003 Barcelona, Spain.

Journal of Clinical Medicine
|February 26, 2025
PubMed

Insights

For patients with advanced chronic liver disease (ACLD), ascites and emergent surgery significantly increase mortality risk, even with recent perioperative improvements. Urgent surgeries in patients with ascites carry the highest risk.

Area of Science:

  • Hepatology
  • Surgical Outcomes
  • Critical Care Medicine

Background:

  • Prognostic factors for advanced chronic liver disease (ACLD) patients undergoing major surgery include liver function, portal hypertension, and surgery urgency/type.
  • Emergent surgery in ACLD patients carries a substantially higher mortality rate (4-10 times) compared to elective procedures.
  • Recent advancements in perioperative management aim to mitigate risks for ACLD patients.

Purpose of the Study:

  • To evaluate the impact of ascites and emergent surgery on perioperative mortality in patients with ACLD.
  • To identify key risk factors influencing outcomes in ACLD patients undergoing major surgical procedures.

Main Methods:

  • Retrospective, observational, unicentric study.
  • Inclusion of 482 ACLD patients who underwent major surgery between 2010 and 2019.
  • Comparison of baseline characteristics and postoperative mortality based on ascites presence, surgery urgency, and surgical period.

Main Results:

  • Ascites was present in 140 (29%) patients; urgent surgery was performed in 191 (39.6%).
  • 90-day mortality was 2.8-fold higher in patients with ascites and 3-fold higher in urgent surgeries.
  • Urgent surgeries combined with ascites presented the highest mortality risk (6.3-fold), persisting even in recent surgical periods (12.8-fold). Portal hypertension was significant in abdominal surgeries.

Conclusions:

  • Ascites and emergent surgery remain significant independent risk factors for increased mortality in ACLD patients.
  • Despite perioperative improvements, the combination of ascites and emergent surgery poses a critical threat to ACLD patient survival.
  • Further research and refined management strategies are needed for high-risk ACLD surgical patients.

Keywords:
advanced chronic liver diseaseascitescirrhosisemergentmortalityportal hypertensionpostoperative risksurgery

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