Early mortality and long-term survival after abdominal surgery in patients with liver cirrhosis.
BACKGROUND
Patients with liver cirrhosis have an increased risk of postoperative mortality. In addition, cirrhotic patients per se have a reduced life expectancy. Little is known about the combined effect of these factors on long-term outcomes after surgery. We thus evaluated early -and long-term survival in patients with cirrhosis who underwent abdominal surgery.


METHODS
We evaluated 30- and 90-day mortality as well as long-term survival after 212 general surgical procedures performed in 194 patients with liver cirrhosis. Risk factors for early and late mortality were assessed by uni- and multivariate methods. To avoid multicollinearity of data, different models (Child Turcotte Pugh [CTP], model for end-stage liver disease [MELD], or American Society of Anesthesiologists [ASA] score) were used in multivariate analysis.


RESULTS
The 30- and 90-day mortality rates were 20% and 30%, respectively. CTP, MELD, and ASA were all independently associated with 30- and 90-day mortality. Although emergency operations and intraoperative transfusions independently influenced 30-day mortality, 90-day mortality also was influenced by the extent of the procedure and thrombocytopenia. Survival after surgery (n = 180) was 54% after one and 25% after 5 years (median survival 1.24 years). Long-term survival was independently influenced by CTP, MELD, ASA, hyponatremia, emergency operations, thrombocytopenia, and underlying malignancies. Survival in patients discharged after surgery (n = 140) was 69% after 1 and 33% after 5 years (median survival 2.8 years). Survival after discharge was independently influenced by MELD, CTP, hyponatremia, underlying malignant disease, and (partially) by serum creatinine. The inclusion of serum sodium into MELD scores did not further facilitate prediction of early and late mortality.


CONCLUSIONS
A high postoperative mortality as well as a strongly reduced survival even after hospital discharge contribute to the very poor life expectancy in patients with liver cirrhosis requiring general surgery. Postoperative outcome is influenced by liver function, comorbidity and "surgical" factors such as the need for blood transfusion and emergent or major operations. However, after hospital discharge, "surgical" factors did not influence survival.
Department of General and Digestive Surgery, University of Freiburg, Freiburg, Germany. Electronic address: hannes.neeff@uniklinik-freiburg.de.
Hannes P
HP
Neeff
Department of General and Digestive Surgery, University of Freiburg, Freiburg, Germany.
Geraldine C
GC
Streule
Department of General and Digestive Surgery, University of Freiburg, Freiburg, Germany.
Oliver
O
Drognitz
Department of General and Digestive Surgery, University of Freiburg, Freiburg, Germany.
Dietlind
D
Tittelbach-Helmrich
Department of Gastroenterology & Hepatology, University of Freiburg, Freiburg, Germany.
Hans-Christian
HC
Spangenberg
Department of General and Digestive Surgery, University of Freiburg, Freiburg, Germany.
Ulrich T
UT
Hopt
Department of General and Digestive Surgery, University of Freiburg, Freiburg, Germany.
Frank
F
Makowiec
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D013505:Digestive System Surgical Procedures / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008103:Liver Cirrhosis / Q000401:mortality* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome