title: Key factors of therapeutic effects for surgery in patients with cirrhotic portal hypertension.
abstract: OBJECTIVE
  In the clinical management of cirrhotic portal hypertension, surgery is often necessary; however, the operative mortality rate is high.
  
  
  METHODS
  Data from 161 patients, who underwent surgery for cirrhotic portal hypertension, were analyzed, and 24 potential predictors of surgical outcome were assessed. A Kruskal-Wallis rank sum test was used for single-factor comparisons, and multivariate logistic regression for multifactor comparisons to identify key factors for poor surgical outcomes and calculate their scores.
  
  
  RESULTS
  Six predictors of poor surgical outcomes were identified: postoperative bleeding within 30 h of > 2 L, with a score of 3; severe liver atrophy (an anteroposterior diameter of the left lobe of ≤ 55 mm and an oblique diameter of the right lobe ≤ 110 mm), with a score of 3; a base excess of <-3 mmol/L, with a score of 3; a platelet count of <3 T/L, with a score of 2; an amount of intraoperative bleeding of > 2 L, with a score of 2; and a red blood cell count of < 3 G/L, with a score of 1. For patients with good outcome (n = 147), all patients had a score of ≤ 3, except one patient who had a score of 4. With respect to patients who died (n = 14), all had a score of ≥ 5, except one patient who had a score of 4. A significant difference was observed between the two groups (p < 0.05). The mortality was 100% in patients with a score of ≥ 7.
  
  
  CONCLUSIONS
  Six key factors for poor surgical outcomes were identified in this study. Operative mortality appears to be significantly increased in patients with a score of 5-6. Surgery should be contraindicated in patients with a score of ≥ 7. To reduce mortality, close attention should be paid to preoperative and intraoperative treatment and prevention to achieve a score of < 4.
authors.affiliation: Department of General Surgery, Hainan Provincial People's Hospital, Haikou, China. liyejuan2009@163.com.
authors.forename: Y-F
authors.initials: YF
authors.lastname: Lv
authors.forename: X-Y
authors.initials: XY
authors.lastname: Han
authors.forename: X-G
authors.initials: XG
authors.lastname: Gong
authors.forename: N
authors.initials: N
authors.lastname: Liu
authors.forename: J
authors.initials: J
authors.lastname: Yue
authors.forename: Y-J
authors.initials: YJ
authors.lastname: Li
authors.forename: S-J
authors.initials: SJ
authors.lastname: Zhang
authors.forename: Y-B
authors.initials: YB
authors.lastname: Pang
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000601:surgery*; D008103:Liver Cirrhosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome