Prognostic factors of cirrhotic patients in extra-hepatic surgery.
BACKGROUND
The surgical approach to a cirrhotic patient is conditioned by a number of variables depending on the emergency and kind of the intervention. It is also related to the evolutionary stage of the liver pathology (evaluated following Child-Pugh score). The present study will explore the physiopathologic mechanisms which should be correlated with the preoperative risk factors responsible for the variation of morbidity and mortality of the hepatopathic patient addressed to an extrahepatic surgical intervention.


METHODS
This study includes a retrospective analysis (from 1992 to 1999) of 40 patients with cirrhosis (80% HCV correlated cirrhosis, 15.5% alcoholic cirrhosis, 2.5% cryptogenic cirrhosis), who underwent such procedures as: colon resection (5), gastrectomy (4), hernioplasty (11), cholecystectomy (14), ulcorraphy (3), laparotomy (3). Patients with hepatic resection and portal shunt are excluded from this study. A pre- and postoperative evaluation of ascites, PT, APTT, albumin, bilirubin and protein value, number of leukocytes and Child-Pugh score was performed on all patients. Their follow-up was 30 days.


RESULTS
The presence of tensive ascites, low albumin value, PT, APTT, together with the emergency of the operation, proved to be significant (p<0.001), in correlation with a mortality of 7.1% in Child's class A, of 23% in class B, and of 84% in class C.


CONCLUSIONS
Cirrhotic patients undergoing elective or emergency surgery can incur significant preoperative risks and postoperative complications, increasing their mortality rate. An accurate preoperative predictive factor is Child's class.
Franzetta
M
M
Department of Surgery, Anatomy and Oncology, University of Palermo, Palermo, Italy. darioraimondo@hotmail.com
Raimondo
D
D
Giammanco
M
M
Di Trapani
B
B
Passariello
P
P
Sammartano
A
A
Di Gesù
G
G
D001778:Blood Coagulation Disorders / Q000209:etiology / Q000401:mortality; D013505:Digestive System Surgical Procedures / Q000706:statistics & numerical data*; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data; D004630:Emergencies; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D011300:Preoperative Care; D011379:Prognosis; D012720:Severity of Illness Index