title: Portal Hypertension: An Underestimated Entity?
abstract: OBJECTIVE
  The aim of this study is to evaluate portal hypertension as an independent risk factor in general surgical procedures.
  
  
  BACKGROUND
  Data on the impact of portal hypertension in general surgical outcomes has been limited. Published literature has focused mainly on its effect in liver surgery. The Child Pugh score and Model for End Stage Liver Disease are utilized for surgical risk assessment in liver disease but they do not accurately reflect degree of portal hypertension.
  
  
  METHODS
  From 2005 to 2012, patients with esophageal varices (EV) in the National Surgical Quality Improvement Program (NSQIP) formed the portal hypertension cohort, and were case matched to patients without esophageal varices (NEV) based on sex, age, surgery type, and year of operation. Thirty day mortality and morbidity were analyzed using generalized estimating equations for binary outcomes. EV patients were also dichotomized by Model for End Stage Liver Disease (MELD) score (≤15 vs >15) and compared with NEV patients.
  
  
  RESULTS
  One thousand five hundred and seventy-four EV patients were matched to 3148 NEV patients. In multivariable analysis, EV patients had a 3.01 higher odds of 30 day mortality (P < 0.001) and 1.28 higher odds of complications (P < 0.001) compared with NEV patients. EV patients with MELD >15 had 4.64 higher odds of death within 30 days (P < 0.001) and had 1.75 higher odds of complications within 30 days (P < 0.001) compared with NEV patients; EV patients with MELD 15 or less had 1.95 higher odds of 30 day mortality (P < 0.001) compared with NEV patients.
  
  
  CONCLUSIONS
  Portal hypertension is associated with a significant mortality and morbidity risk in general surgery, and should not be underestimated even in patients with MELD 15 or less where the early mortality risk remained significant.
authors.affiliation: *Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA †Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, PA ‡Division of Gastroenterology, College of Medicine, The Pennsylvania State University, Hershey, PA §Department of Medicine, The Pennsylvania State University, Hershey, PA ¶Department of Anesthesiology, College of Medicine, The Pennsylvania State University, Hershey, PA.
authors.forename: Zakiyah
authors.initials: Z
authors.lastname: Kadry
authors.forename: Eric W
authors.initials: EW
authors.lastname: Schaefer
authors.forename: Riaz Ali
authors.initials: RA
authors.lastname: Shah
authors.forename: Karen
authors.initials: K
authors.lastname: Krok
authors.forename: Ping
authors.initials: P
authors.lastname: Du
authors.forename: Dmitri
authors.initials: D
authors.lastname: Bezinover
authors.forename: Piotr
authors.initials: P
authors.lastname: Janicki
authors.forename: Ashokkumar
authors.initials: A
authors.lastname: Jain
authors.forename: Niraj J
authors.initials: NJ
authors.lastname: Gusani
authors.forename: Ian R
authors.initials: IR
authors.lastname: Schreibman
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Hollenbeak
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Riley
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004932:Esophageal and Gastric Varices / Q000601:surgery*; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000453:epidemiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology