title: Complications associated with instrumented lumbar surgery in patients with liver cirrhosis: a matched cohort analysis.
abstract: BACKGROUND
  There is no information in the English literature on the outcome of liver cirrhotic patients who have undergone instrumented lumbar surgery.
  
  
  OBJECTIVE
  To review the results of instrumented lumbar surgery in patients with liver cirrhosis and determine the surgical risk factors in this group of patients.
  
  
  METHODS
  A retrospective study for comparison between two cohorts (liver cirrhosis vs. nonliver cirrhosis).
  
  
  METHODS
  Fifty-eight patients.
  
  
  METHODS
  Child-Turcotte-Pugh scale was used to assess the patients' hepatic functional reserve. The clinical outcomes were evaluated by the five-grade patient-centered general outcome assessment questionnaire. Any event that led to reoperation, requirement of intensive care, prolonging of the hospital stay (more than 14 days), or admission after discharge within 30 days of surgery was defined as a perioperative complication.
  
  
  METHODS
  Between 1997 and 2009, patients with liver cirrhosis who had undergone instrumented lumbar surgeries for degenerative lumbar disease were studied. All data were compared with those for gender-, age-, and diagnosis-matched nonliver cirrhosis patients.
  
  
  RESULTS
  Liver cirrhotic patients had significantly lower preoperative hemoglobin, white blood cell counts, platelets, and albumin levels and higher prothrombin time and bilirubin level. Instrumented lumbar surgery was associated with significantly more blood loss, a longer hospital stay, and more complications in patients with liver cirrhosis compared with control patients. The final satisfactory rate was higher in the control group but without statistical difference (85% vs. 65%, p=.240). In the cirrhotic group, 22 patients (76%) were Child Class A and 7 patients (24%) were Child Class B; 12 patients developed one or more complications. Patients with Child Class B had a significantly higher incidence of complications than those with Child Class A (p=.006). In patients with Child Class A, those with a score of 6 also had a significantly higher incidence of complications than those with a score of 5 (p<.001). Female gender (p=.035), a low level of albumin (p=.002), presence of ascites (p=.029), and increased blood loss (p=.044) were associated with a higher risk of complications.
  
  
  CONCLUSIONS
  The rate of complications after instrumented lumbar surgery was significantly higher in patients with cirrhosis than in control patients, especially in those with 6 or more Child-Turcotte-Pugh points. The surgeon should counsel these patients on the possibility of developing early complications. Several factors were associated with surgical complications and should be addressed by the spine surgeons before or when they perform these elective instrumented lumbar surgeries.
authors.affiliation: Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chang Gung University, Fu-Shin St, Kweishian, Taoyuan 333, Taiwan. johnliao1002@gmail.com
authors.forename: Jen-Chung
authors.initials: JC
authors.lastname: Liao
authors.forename: Wen-Jer
authors.initials: WJ
authors.lastname: Chen
authors.forename: Lih-Hui
authors.initials: LH
authors.lastname: Chen
authors.forename: Chi-Chien
authors.initials: CC
authors.lastname: Niu
authors.forename: Tsai-Shen
authors.initials: TS
authors.lastname: Fu
authors.forename: Po-Liang
authors.initials: PL
authors.lastname: Lai
authors.forename: Tsung-Ting
authors.initials: TT
authors.lastname: Tsai
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000601:surgery; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000209:etiology*; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013122:Spinal Diseases / Q000150:complications / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects* / Q000295:instrumentation; D016896:Treatment Outcome
keywords: Child-Turcotte-Pugh score; Complications; Degenerative lumbar disease; Instrumented lumbar surgery; Liver cirrhosis