title: Clinical outcomes of oncologic gastrointestinal resections in patients with cirrhosis.
abstract: BACKGROUND
  Cirrhosis is a risk factor for postoperative morbidity and mortality after general surgical procedures. However, the impact of cirrhosis on outcomes of surgical resection for gastrointestinal (GI) malignancies has not been described. The authors' objective was to characterize early postoperative and transitional outcomes in cirrhotic patients undergoing GI cancer surgery.
  
  
  METHODS
  Query of the National Inpatient Sample Database (2005-2008) identified 106,729 patients who underwent resection for GI malignancy; 1479 (1.4%) had cirrhosis. The association of cirrhosis with postoperative outcomes was examined. The primary outcome measure was in-hospital mortality. Secondary outcomes included length-of-stay (LOS) and discharge to long-term care facility (LTCF).
  
  
  RESULTS
  Cirrhotic patients had higher risk of in-hospital mortality (8.9% vs 2.8%, P < .001), longer LOS (11.5 ± 0.26 vs 10.0 ± 0.03 days, P < .001), and higher rate of discharge to LTCF (19.0% vs 15.7%, P < .001). Mortality was highest in patients with moderate to severe liver dysfunction (21.5% vs 6.5%, P < .001). On multivariate analysis, cirrhosis was an independent predictor of in-hospital mortality (odds ratio [OR], 3.0; 95% confidence interval [CI] 2.5-3.7) and nonhome discharge (OR, 1.7; 95% CI, 1.4-2.0). In cirrhotic patients, moderate to severe liver dysfunction was the only independent predictor of in-hospital mortality (OR, 4.03; 95% CI, 2.7-5.9), but did not predict discharge disposition.
  
  
  CONCLUSIONS
  Resection of GI malignancy in cirrhotics is associated with poor early postoperative and transitional outcomes, with severity of liver disease being the primary determinant of postoperative mortality. These data suggest that GI cancer operations can be performed safely in well-selected cirrhotic patients with mild liver dysfunction.
authors.affiliation: Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX 77005, USA. artinyan@bcm.edu
authors.forename: Avo
authors.initials: A
authors.lastname: Artinyan
authors.forename: Christy L
authors.initials: CL
authors.lastname: Marshall
authors.forename: Courtney J
authors.initials: CJ
authors.lastname: Balentine
authors.forename: Daniel
authors.initials: D
authors.lastname: Albo
authors.forename: Sonia T
authors.initials: ST
authors.lastname: Orcutt
authors.forename: Samir S
authors.initials: SS
authors.lastname: Awad
authors.forename: David H
authors.initials: DH
authors.lastname: Berger
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Anaya
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge; D011159:Population Surveillance; D011184:Postoperative Period; D012307:Risk Factors