title: Factors that predict outcome of abdominal operations in patients with advanced cirrhosis.
abstract: OBJECTIVE
  Patients with cirrhosis have an increased risk of complications during surgery that is relative to the severity of liver disease; it is a challenge to determine which patients are the best candidates for surgery. We performed a hospital-based study to identify factors that might facilitate selection of operative candidates and guide their management.
  
  
  METHODS
  A retrospective review was performed of 100 cirrhotic patients (50 classified as Child-Turcotte-Pugh [CTP] A, 33 as CTP B, and 17 as CTP C) who underwent abdominal surgery at an institution specializing in liver medicine and transplant from 2002-2008. Significant univariate variables were evaluated by multivariate logistic regression models to identify factors that correlate with outcome.
  
  
  RESULTS
  The overall, 30-day postoperative mortality rate was 7%. The mortality for patients who were CTP A was 2%, CTP B was 12%, and CTP C was 12%; 33 patients had a Model for End-Stage Liver Disease (MELD) score >or=15, with 29% mortality. On the basis of multivariate analyses, risk factors for adverse outcome were American Society of Anesthesiologists (ASA) score >3; procedures being emergent; intraoperative blood transfusion; intraoperative blood loss >150 mL; presence of ascites; total bilirubin level >1.5 mg/dL; and albumin level <3 mg/dL. Addition of serum albumin to MELD score showed that patients with MELD score >or=15 and albumin <or=2.5 mg/dL (vs >2.5 mg/dL) had significantly increased mortality (60% vs 14%, P < .01) and independently increased probability of adverse outcome (odds ratio, 8.4; P = .015).
  
  
  CONCLUSIONS
  For patients with MELD scores >or=15, the preoperative albumin level correlates with outcome and could guide operative decisions. Intraoperative packed red blood cell transfusion correlates with adverse outcome and should be limited.
authors.affiliation: Division of General Surgery, Department of Surgery, The Mount Sinai Hospital, New York, New York, USA.
authors.forename: Dana A
authors.initials: DA
authors.lastname: Telem
authors.forename: Thomas
authors.initials: T
authors.lastname: Schiano
authors.forename: Robert
authors.initials: R
authors.lastname: Goldstone
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Han
authors.forename: Kerri E
authors.initials: KE
authors.lastname: Buch
authors.forename: Edward H
authors.initials: EH
authors.lastname: Chin
authors.forename: Scott Q
authors.initials: SQ
authors.lastname: Nguyen
authors.forename: Celia M
authors.initials: CM
authors.lastname: Divino
mesh_terms: D000005:Abdomen / Q000601:surgery*; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality; D012189:Retrospective Studies; D012709:Serum Albumin / Q000032:analysis; D012720:Severity of Illness Index
chemical_list: D012709:Serum Albumin