title: Surgical risks and perioperative complications of instrumented lumbar surgery in patients with liver cirrhosis.
abstract: BACKGROUND
  Patients with liver cirrhosis have high surgical risks due to malnutrition, impaired immunity, coagulopathy, and encephalopathy. However, there is no information in English literature about the results of liver cirrhotic patients who underwent instrumented lumbar surgery. The purpose of this study is to report the perioperative complications, clinical outcomes and determine the surgical risk factors in cirrhotic patients.
  
  
  METHODS
  We retrospectively reviewed 29 patients with liver cirrhosis who underwent instrumented lumbar surgery between 1997 and 2009. The hepatic functional reserves of the patients were recorded according to the Child-Turcotte-Pugh scoring system. Besides, fourteen other variables and perioperative complications were also collected. To determine the risks, we divided the patients into two groups according to whether or not perioperative complications developed.
  
  
  RESULTS
  Of the 29 patients, 22 (76%) belonged to Child class A and 7 (24%) belonged to Child class B. Twelve patients developed one or more complications. Patients with Child class B carried a significantly higher incidence of complications than those with Child class A (p = 0.011). In the Child class A group, patients with 6 points had a significantly higher incidence of complications than those with 5 points (p = 0.025). A low level of albumin was significantly associated with higher risk, and a similar trend was also noted for the presence of ascites although statistical difference was not reached.
  
  
  CONCLUSIONS
  The study concludes that patients with liver cirrhosis who have undergone instrumented lumbar surgery carry a high risk of developing perioperative complications, especially in those with a Child-Turcotte-Pugh score of 6 or more.
authors.forename: Tung-Yi
authors.initials: TY
authors.lastname: Lin
authors.affiliation: Department of Orthopedics, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: Jen-Chung
authors.initials: JC
authors.lastname: Liao
authors.forename: Wen-Jer
authors.initials: WJ
authors.lastname: Chen
authors.forename: Lih-Huei
authors.initials: LH
authors.lastname: Chen
authors.forename: Chi-Chien
authors.initials: CC
authors.lastname: Niu
authors.forename: Tsai-Sheng
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: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D059035:Perioperative Period; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome