title: [Surgical risk and complications after major surgery in patients with cirrhosis].
abstract: In this study we report the morbidity and the mortality observed in 55 patients with cirrhosis who had a major surgical procedure between October 1986 and June 1988, as well as its relation with different variables. The overall mortality was 34.5% and it was due to multiple organ failure or bleeding because of coagulopathy in 18 of 19 patients. The preoperative variables associated with major mortality were: emergency surgery, classification 3 or 4 of the American Society of Anesthesiology (ASA) and poor hepatic reserve evaluated with the Child Turcotte classification (the mortality for A group was 16%, B 62%, and C 100%). The transoperative hypotension increased the mortality 4.5 times. In the postoperative period an elevated APACHE (Acute Physiologic and Chronic Health Evaluation) II score (mortality of 100% in those with greater than 20 points), multiple organic failure (100% died with 2 or more organ failures) or surgical reintervention in the patients with Child A increased significatively the mortality. The 24 patients who survived without complications were discharged on the 19th day (+/- 9 S.D.), while those with complications stayed during 46 days (+/- 18 S.D.).
authors.affiliation: Departamento de Medicina Crítica, Instituto Nacional de la Nutrición Salvador Zubirán, México, D.F.
authors.forename: A
authors.initials: A
authors.lastname: Ramírez Guerrero
authors.forename: D
authors.initials: D
authors.lastname: Arizpe Bravo
mesh_terms: D016063:Blood Loss, Surgical / Q000401:mortality; D006801:Humans; D007431:Intraoperative Complications / Q000401:mortality; D008103:Liver Cirrhosis / Q000150:complications*; D008800:Mexico / Q000453:epidemiology; D009102:Multiple Organ Failure / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality*; D012307:Risk Factors; D013514:Surgical Procedures, Operative
vernacular_title: Riesgo quirúrgico y complicaciones después de cirugía mayor en pacientes con cirrosis.