title: Morbidity and mortality related to non-hepatic surgery in patients with liver cirrhosis: a systematic review.
abstract: BACKGROUND
  The aim of this study is to review systematically morbidity and mortality after non-hepatic surgery in patients with liver cirrhosis.
  
  
  METHODS
  Comprehensive searches were conducted in PubMed, Embase and the Cochrane Library for articles using the words: liver failure, hepatic insufficiency, liver cirrhosis, cirrhosis, cirrhotic, surgical procedures, operative complications, operative mortality, postoperative complications, surgical complication, surgical risk, hernia.
  
  
  RESULTS
  Forty-six articles were selected from 5247 included after the initial search. Level of evidence provided in the articles varied greatly. Non-hepatic surgery of patients with cirrhosis resulted in increased postoperative morbidity and mortality compared to similar surgery for non-cirrhotic patients. Cholecystectomy and umbilical and inguinal hernia correction were associated with the lowest increased morbidity and mortality while pancreatic surgery, cardiovascular, and trauma surgery correlated with the highest. The preoperative model for end stage liver disease (MELD) and Child-Turcotte-Pugh (CTP) scores appeared to be predictive of postoperative risks. Portal hypertension and surgery in the emergency setting were associated with extra increased mortality and morbidity rates.
  
  
  CONCLUSIONS
  This systematic review of the literature showed that in patients with liver cirrhosis who undergo non-hepatic surgery, postoperative morbidity and mortality rates varied greatly depending on severity of the cirrhosis and the surgical procedure. However, the majority of procedures can be safely performed in patients with low MELD scores or CTP A cirrhosis without portal hypertension.
authors.affiliation: Erasmus University Medical Center, Department of Surgery, Medical Center, Rotterdam, The Netherlands.
authors.forename: B
authors.initials: B
authors.lastname: de Goede
authors.forename: P J
authors.initials: PJ
authors.lastname: Klitsie
authors.forename: J F
authors.initials: JF
authors.lastname: Lange
authors.forename: H J
authors.initials: HJ
authors.lastname: Metselaar
authors.forename: G
authors.initials: G
authors.lastname: Kazemier
mesh_terms: D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000401:mortality*; D009017:Morbidity; D011183:Postoperative Complications / Q000401:mortality*; D012720:Severity of Illness Index; D013514:Surgical Procedures, Operative / Q000009:adverse effects / Q000401:mortality*; D015996:Survival Rate