Risk Factors for Mortality After Surgery in Patients With Cirrhosis
ABSTRACT Current methods of predicting risk of postoperative mortality in patients with cirrhosis are suboptimal. The utility of the Model for End-stage Liver Disease (MELD) in predicting mortality after surgery other than liver transplantation is unknown. The aim of this study was to determine the risk factors for postoperative mortality in patients with cirrhosis.
Patients with cirrhosis (N = 772) who underwent major digestive (n = 586), orthopedic (n = 107), or cardiovascular (n = 79) surgery were studied. Control groups of patients with cirrhosis included 303 undergoing minor surgical procedures and 562 ambulatory patients. Univariate and multivariable proportional hazards analyses were used to determine the relationship between risk factors and mortality.
Patients undergoing major surgery were at increased risk for mortality up to 90 days postoperatively. By multivariable analysis, only MELD score, American Society of Anesthesiologists class, and age predicted mortality at 30 and 90 days, 1 year, and long-term, independently of type or year of surgery. Emergency surgery was the only independent predictor of duration of hospitalization postoperatively. Thirty-day mortality ranged from 5.7% (MELD score, <8) to more than 50% (MELD score, >20). The relationship between MELD score and mortality persisted throughout the 20-year postoperative period.
MELD score, age, and American Society of Anesthesiologists class can quantify the risk of mortality postoperatively in patients with cirrhosis, independently of the procedure performed. These factors can be used in determining operative mortality risk and whether elective surgical procedures can be delayed until after liver transplantation.
Full-textDOI: · Available from: Jayant A Talwalkar, Sep 29, 2014
- SourceAvailable from: Lawrence S Friedman
[Show abstract] [Hide abstract]
- "ween operative mortality and MELD score in 772 patients with cirrhosis who underwent surgery in 1980 –1990 and 1994 –2004. Panel A: shows 30-day mortality; Panel B: shows 90-day mortality. For patients with a MELD score Ͼ8, each one-point increase in the MELD score was associated with a 14% increase in both 30-day and 90-day mortality rates. (From Teh SH, Nagorney DM, Stevens SR, et al. Gastroenterology 2007;132:1261–9, with permission.) MELD, Model for End-Stage Liver Disease. risk (19). An ASA class of IV added the equivalent of 5.5 MELD points to the mortality rate, whereas an ASA class of V was associated with a 100% mortality rate. The influence of the ASA class was greatest in the first 7 days after surgery, after which the MELD score"
ABSTRACT: Surgery is performed in patients with liver disease more frequently now than in the past, in part because of the long-term survival of patients with cirrhosis. Recent work has focused on estimating perioperative risk in patients with liver disease. Hemodynamic instability in the perioperative period can worsen liver function in patients with liver disease. Operative risk correlates with the severity of the underlying liver disease and the nature of the surgical procedure. Thorough preoperative evaluation is necessary prior to elective surgery. Surgery is contraindicated in patients with certain conditions, such as acute hepatitis, acute liver failure, and alcoholic hepatitis. Estimation of perioperative mortality is inexact because of the retrospective nature of and biased patient selection in available clinical studies. The Child-Pugh classification (Child-Turcotte-Pugh score) and particulary the Model for End-Stage Liver Disease (MELD) score provide reasonable estimations of perioperative mortality but do not replace the need for careful preoperative preparation and postoperative monitoring, as early detection of complications is essential for improving outcomes. Medical therapy for specific manifestations of hepatic disease, including ascites, encephalopathy, and renal dysfunction, should be optimized preoperatively or, if necessary, administered in the postoperative period.Transactions of the American Clinical and Climatological Association 01/2010; 121:192-204; discussion 205.
- [Show abstract] [Hide abstract]
ABSTRACT: Hepatic venous pressure gradient (HVPG) measurement has evolved into an extremely useful procedure for the assessment of portal hypertensive patients and in the prediction and management of portal hypertension-related events. Although invasive and not widely available, its safety and reproducibility can be warranted when performed in referral centers and following accepted guidelines. Well-established manometric HVPG cut off are reliable targets in the therapy of portal hypertension. When adequately indicated and performed, HVPG measurement provides valuable information allowing to establish diagnosis, elaborate prognosis, evaluate therapy and, most importantly, to make therapeutic decisions in portal hypertensive patients.Journal of Clinical Gastroenterology 01/2007; 41 Suppl 3(Suppl 3):S336-43. DOI:10.1097/MCG.0b013e31814684d3 · 3.19 Impact Factor
- Gastroenterology 04/2007; 132(4):1609-11. DOI:10.1053/j.gastro.2007.03.016 · 13.93 Impact Factor