Abdominal operations in patients with cirrhosis: still a major surgical challenge.
BACKGROUND
Hepatic transplantation and portasystemic shunts can be safely performed in patients with advanced liver disease, whereas other abdominal procedures appear to have a much higher mortality rate. This study reviews the outcomes of patients with cirrhosis after the full spectrum of abdominal operations.


METHODS
In a 12-year period, 92 patients diagnosed with cirrhosis required either an emergent or elective abdominal operation. There were four categories of operations: cholecystectomy in 17 patients, hernia in 9, gastrointestinal tract in 54, and other procedures in 12. Fifty-five clinical, laboratory, and operative variables were analyzed to identify factors predictive of poor outcome.


RESULTS
Coagulopathy developed in 24 patients (27%) and sepsis in 15 (16%). The mortality rate after emergent operations was 50%, compared to 18% for elective cases (p = 0.001). Other factors that predicted mortality included the presence of ascites (p = 0.006), encephalopathy (p = 0.002), and elevated prothrombin time (p = 0.021). The mortality in Child's class A patients was 10%, compared to 30% in class B and 82% in class C patients.


CONCLUSIONS
Patients with cirrhosis undergoing elective or emergent operations are at a significant risk of developing postoperative complications leading to death. The most accurate predictor of outcome is the patient's preoperative Child's class.
Mansour
A
A
Department of Surgery, Loyola University Stritch School of Medicine, Maywood, Ill., USA.
Watson
W
W
Shayani
V
V
Pickleman
J
J
D000006:Abdomen, Acute / Q000601:surgery*; D000328:Adult; D001706:Biopsy; D002763:Cholecystectomy / Q000401:mortality; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000601:surgery*; D006801:Humans; D008103:Liver Cirrhosis / Q000145:classification / Q000150:complications* / Q000473:pathology; D008104:Liver Cirrhosis, Alcoholic / Q000145:classification / Q000150:complications* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D013514:Surgical Procedures, Operative / Q000401:mortality; D014949:Wounds, Nonpenetrating / Q000601:surgery*; D014950:Wounds, Penetrating / Q000601:surgery*