title: Adverse outcomes in patients with chronic liver disease undergoing colorectal surgery.
abstract: OBJECTIVE
  We sought to use a multi-institutional, prospective, clinical database to better understand adverse outcomes in chronic liver disease (CLD) patients undergoing colorectal surgery.
  
  
  BACKGROUND
  CLD confers significant perioperative risk. However, there are little population-based data available for prognostication and risk stratification in these patients.
  
  
  METHODS
  We used data from the 2005-2007 American College of Surgeons National Surgical Quality Improvement Project to study 30,927 patients undergoing colorectal resections. We first identified patients with CLD (n = 1565) with any of the following clinical characteristics: ascites, esophageal varices, or total bilirubin greater than 2 mg/dL. Postoperative complications and mortality rates were then compared between CLD and non-CLD patients.
  
  
  RESULTS
  CLD patients have a nearly 6.5-fold increased risk of mortality following colorectal operations (Relative Risk [RR], 6.53; 3.2% in non-CLD group versus 21.5% in CLD group). Patients with CLD also had significantly higher major complication rates (RR, 2.72; 15.4% vs. 41.9%, respectively). The failure to rescue rate (ie, proportion of deaths following major complications) was also markedly higher in patients with CLD (RR, 2.27; 15.1% vs. 34.2%, respectively). Furthermore, stratification of CLD patients by Model for End-stage Liver Disease (MELD) score demonstrated significantly higher rates of complications (RR, 2.41; 2.31-2.51), failure to rescue (RR, 2.62; 2.35-2.90), and mortality (RR, 8.92; 8.11-9.78) in CLD patients with MELD > or =15 compared with CLD patients with MELD <15.
  
  
  CONCLUSIONS
  Colorectal surgery in CLD patients is associated with significant morbidity and mortality. Furthermore, those who develop major complications have a significantly higher risk of death compared to non-CLD. These very high risks should be discussed at length with patients prior to undertaking major surgical procedures.
authors.affiliation: Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA. aghaferi@umich.edu
authors.forename: Amir A
authors.initials: AA
authors.lastname: Ghaferi
authors.forename: Amit K
authors.initials: AK
authors.lastname: Mathur
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Sonnenday
authors.forename: Justin B
authors.initials: JB
authors.lastname: Dimick
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D002908:Chronic Disease; D003107:Colorectal Surgery / Q000401:mortality; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000150:complications* / Q000401:mortality; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors