title: Laparoscopic cholecystectomy in the cirrhotic patient: predictors of outcome.
abstract: BACKGROUND
  We sought to determine the outcome predictors of 94 cirrhotic patients undergoing laparoscopic cholecystectomy (LC).
  
  
  METHODS
  We performed a single-center, retrospective review of cirrhotic patients undergoing LC for symptomatic gallbladder disease. Statistical analysis was completed using the Chi-square, Wilcoxon rank-sum, and Student t tests as appropriate.
  
  
  RESULTS
  Ninety-four procedures were completed. The median Child-Turcotte-Pugh (CTP) score was 6 (range, 5-12), and the average Model for End-Stage Liver Disease (MELD) score was 11 ± 5. Hepatitis C was the most common etiology of liver disease (50%) followed by Laennec's cirrhosis (22%). The average length of stay was 2.6 ± 4.3 days; 21% were outpatient procedures. The conversion rate was 11%. Conversion risk factors were decreased serum albumin, increased MELD score, and blood loss. Morbidity occurred in 32 patients. Predictors of morbidity were decreases in serum albumin, increases in International Normalized Ratio (INR) and CTP score, and the number of intraoperative red blood cell transfusions. Mortality occurred in 4 patients. Increased INR, CTP score, CTP class, the number of intraoperative blood and platelet transfusions were predictors of mortality.
  
  
  CONCLUSIONS
  LC can be safely performed in cirrhotic patients with appropriate patient selection. Liver synthetic function, operative blood loss, transfusion requirement, CTP, and MELD scores may be used to predict outcomes in these patients.
authors.affiliation: Department of Surgery, University of Cincinnati, Cincinnati, OH 45267-0558, USA. cutlerquillin@gmail.com
authors.forename: Ralph C
authors.initials: RC
authors.lastname: Quillin
authors.forename: Justin M
authors.initials: JM
authors.lastname: Burns
authors.forename: Jaime A
authors.initials: JA
authors.lastname: Pineda
authors.forename: Dennis
authors.initials: D
authors.lastname: Hanseman
authors.forename: Steven M
authors.initials: SM
authors.lastname: Rudich
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Edwards
authors.forename: Amit D
authors.initials: AD
authors.lastname: Tevar
mesh_terms: D000328:Adult; D000368:Aged; D017081:Cholecystectomy, Laparoscopic / Q000401:mortality; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data; D058625:End Stage Liver Disease / Q000150:complications* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D005705:Gallbladder Diseases / Q000150:complications / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008103:Liver Cirrhosis / Q000150:complications* / Q000401:mortality; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018579:Patient Selection; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome