Patients with cirrhosis may be at high mortality risk from nonrelated abdominal surgery

SAN DIEGO — Patients with cirrhosis have significantly reduced long-term survival rates for general abdominal surgery, including procedures that do not involve the liver, according to data published at the 2012 Digestive Disease Week Annual Meeting.

Researchers evaluated the survival rates of 180 patients with cirrhosis for up to 5 years following various surgical procedures. A separate analysis was conducted on 143 of the patients, excluding those who died in-hospital following surgery or did not have survival information available. Risk factors for decreased survival rates were determined through univariate and multivariate analysis.

The survival rate among the initial 180 patients was 54% after 1 year and 25% after 5 years, with a median rate of 1.24 years. Multivariate analysis associated factors including CHILD scores (P<.02), MELD scores (P<.001) and ASA class (P<.01) with poorer survival.

Among the 143 patients who survived procedures and were discharged, 68% survived after 1 year and 32% after 5 years, with a median of 2.8 years. Multivariate analysis significantly associated MELD scores (P<.001) and hyponatremia (P<.01) with poor prognosis, but not CHILD scores (P=.06). Other factors, including age, emergency as opposed to elective surgery, or underlying malignant disease, were not independently associated with long-term survival rates.

“Unfortunately, we found out that patients who were successfully operated on and could be discharged from the hospital at any given time still have a very poor survival rate over the following 5 years,” researcher Hannes P. Neeff, MD, told Healio.com. “All people with liver cirrhosis are at extremely high risk at any surgical procedure, even if it seems like a small, outpatient surgery. This [includes] all abdominal or abdominal wall surgeries … [patients] can have very bad outcomes even with standard operations not related to the liver.”

For more information:

Neeff HP. #Mo1494: Prediction of Survival After Surgery in Patients With Liver Cirrhosis. Presented at: the 2012 Digestive Disease Week Annual Meeting; May 19-22, San Diego.