Brain surgery in patients with liver cirrhosis.
OBJECTIVE
Liver cirrhosis was identified as an independent predictor of poor outcomes in patients suffering trauma and in those undergoing major surgeries. The aim of this study was to report the authors' experiences treating patients with cirrhosis who undergo brain surgeries.


METHODS
Between 2004 and 2009, 121 consecutive patients with cirrhosis underwent 144 brain procedures. Patients were categorized as Child-Turcotte-Pugh (referred to as "Child") Class A, B, or C. The patient profiles, including the severity of cirrhosis, reason for surgery, complications, and prognosis factors, were analyzed.


RESULTS
In this retrospective study, the overall surgical complication rate for patients with cirrhosis was 52.1% and the mortality rate was 24.3%. For patients with acute traumatic brain injury (TBI), the complication, rebleeding, and mortality rates reached 84.4%, 68.8%, and 37.5%, respectively. Surgery for TBI was a significant risk factor for postoperative complications (p = 0.0002) and postoperative hemorrhage (p < 0.0001). Otherwise, according to the Child classification, the complication rate increased in a stepwise fashion from 38.7% to 60% to 84.2%, the rebleeding rate from 29.3% to 48.0% to 63.2%, and the mortality rate from 5.3% to 38% to 63.2% for Child A, B, and C, respectively. The Child classification was associated with higher risk of complications-Child B vs A OR 2.84 (95% CI 1.28-6.29), Child C vs A OR 5.39 (95% CI 1.32-22.02). It was also associated with risk of death-Child C vs A OR 30.43 (95% CI 7.71-120.02), Child B vs A OR 10.88 (95% CI 3.42-34.63).


CONCLUSIONS
Liver cirrhosis is a poor comorbidity factor for brain surgery. The authors' results suggest that the Child classification used independently is a poor prognostic factor; in addition, grave outcomes were observed in patients with TBI.
Department of Neurosurgery, Chang Gung University and Chang Gung Memorial Hospital-Linkou, Kwei-Shan, Taiwan.
Ching-Chang
CC
Chen
Peng-Wei
PW
Hsu
Shih-Tseng
ST
Lee
Chen-Nen
CN
Chang
Kuo-Chen
KC
Wei
Chieh-Tsai
CT
Wu
Yung-Hsin
YH
Hsu
Tzu-Kang
TK
Lin
Sai-Cheung
SC
Lee
Yin-Cheng
YC
Huang
D000328:Adult; D000368:Aged; D001927:Brain Diseases / Q000401:mortality / Q000601:surgery*; D001930:Brain Injuries / Q000401:mortality / Q000601:surgery*; D001932:Brain Neoplasms / Q000401:mortality / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000401:mortality / Q000503:physiopathology*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology*; D019106:Postoperative Hemorrhage / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate