title: Liver disease and 30-day mortality after colorectal cancer surgery: a Danish population-based cohort study.
abstract: BACKGROUND
  Colorectal cancer (CRC) is common, with surgery as the main curative treatment. The prevalence of chronic liver disease has increased, but knowledge is limited on postoperative mortality in patients with liver disease who undergo CRC surgery. Hence, we examined 30-day mortality after CRC surgery in patients with liver disease compared to those without liver disease.
  
  
  METHODS
  We used medical databases to conduct a nationwide cohort study of all patients undergoing CRC surgery in Denmark from 1996 through 2009. We further identified patients diagnosed with any liver disease before CRC surgery and categorized them into two cohorts: patients with non-cirrhotic liver disease and patients with liver cirrhosis. Patients without liver disease were defined as the comparison cohort. Using the Kaplan-Meier method, we computed 30-day mortality after CRC surgery in each cohort. We used a Cox regression model to compute hazard ratios as measures of the relative risk (RR) of death, controlling for potential confounders including comorbidities. In order to examine the impact of liver disease in different subgroups, we stratified patients by gender, age, cancer stage, cancer site, timing of admission, type of surgery, comorbidity level, and non-hepatic alcohol-related disease.
  
  
  RESULTS
  Overall, 39,840 patients underwent CRC surgery: 369 (0.9%) had non-cirrhotic liver disease and 158 (0.4%) had liver cirrhosis. Thirty-day mortality after CRC surgery was 8.7% in patients without liver disease and 13.3% in patients with non-cirrhotic liver disease (adjusted RR of 1.49 95% confidence interval (CI): 1.12-1.98). Among patients with liver cirrhosis, mortality was 24.1%, corresponding to an adjusted RR of 2.59 (95% CI: 1.86-3.61). The negative impact of liver disease on postoperative mortality was found in all subgroups.
  
  
  CONCLUSIONS
  Pre-existing liver disease was associated with a markedly increased 30-day mortality following CRC surgery.
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, Aarhus N DK-8200, Denmark. jm@dce.au.dk
authors.forename: Jonathan
authors.initials: J
authors.lastname: Montomoli
authors.forename: Rune
authors.initials: R
authors.lastname: Erichsen
authors.forename: Christian Fynbo
authors.initials: CF
authors.lastname: Christiansen
authors.forename: Sinna Pilgaard
authors.initials: SP
authors.lastname: Ulrichsen
authors.forename: Lars
authors.initials: L
authors.lastname: Pedersen
authors.forename: Tove
authors.initials: T
authors.lastname: Nilsson
authors.forename: Henrik Toft
authors.initials: HT
authors.lastname: Sørensen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D015179:Colorectal Neoplasms / Q000401:mortality* / Q000601:surgery*; D015897:Comorbidity; D016001:Confidence Intervals; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000401:mortality; D008107:Liver Diseases / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D013997:Time Factors; D055815:Young Adult