The Impact of Cirrhosis and Portal Hypertension on Mortality Following Colorectal Surgery: A Nationwide, Population-Based Study
- 1 August 2009
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Diseases of the Colon & Rectum
- Vol. 52 (8), 1367-1374
- https://doi.org/10.1007/dcr.0b013e3181a80dca
Abstract
Population-based data on outcomes associated with colorectal procedures in cirrhotic patients are sparse. We sought to assess the impact of liver cirrhosis and portal hypertension on mortality following colorectal surgery. We queried patients who underwent colorectal surgery in the United States in the Nationwide Inpatient Sample (1998-2005). In-hospital mortality was determined for patients with no cirrhosis, compensated cirrhotic patients, and cirrhotic patients with portal hypertension. Multivariate logistic regression analysis was used to adjust for sociodemographic and clinical covariates. Patients with cirrhosis and cirrhosis with portal hypertension had significantly higher in-hospital mortality than patients with no cirrhosis (14% and 29% vs. 5%, respectively, P < 0.0001). In-hospital mortality was also significantly higher for emergent and urgent colorectal procedures compared with elective procedures (9.2% vs. 1.8%, P < 0.0001). Among elective colorectal procedures, adjusted mortality was increased in cirrhotic patients (adjusted odds ratio, 3.91; 95% confidence interval, 3.12-4.90) and cirrhotic patients with portal hypertension (adjusted odds ratio, 11.3; 95% confidence interval, 8.46-15.1) compared with patients with no cirrhosis. For nonelective procedures, the adjusted odds ratio for mortality in cirrhotic patients was 2.40 (95% confidence interval, 2.07-2.79) and in cirrhotic patients with portal hypertension the adjusted odds ratio was 5.88 (95% confidence interval, 4.90-7.06). Postoperative complications were more likely in cirrhotic patients (adjusted odds ratio, 1.35; 95% confidence interval, 1.20-1.52) and cirrhotic patients with portal hypertension (adjusted odds ratio, 1.82; 95% confidence interval, 1.55-2.15) relative to patients with no cirrhosis. Patients with liver cirrhosis, in particular, those with portal hypertension, have increased in-hospital mortality and morbidity following colorectal surgery. Strategies are needed to optimize preoperative risk.Keywords
This publication has 21 references indexed in Scilit:
- Colorectal Surgery in Cirrhotic Patients: Assessment of Operative Morbidity and MortalityDiseases of the Colon & Rectum, 2008
- Aging Liver and HepatitisClinics in Geriatric Medicine, 2007
- Worldwide mortality from cirrhosis: An update to 2002Journal of Hepatology, 2007
- Outcomes of patients with cirrhosis undergoing non-hepatic surgery: Risk assessment and managementWorld Journal of Gastroenterology, 2007
- Projecting future complications of chronic hepatitis C in the United StatesLiver Transplantation, 2003
- Surgery in the patient with liver diseaseMedical Clinics of North America, 2003
- Morbidity and Mortality in Cirrhotic Patients Undergoing Anesthesia and SurgeryAnesthesiology, 1999
- Abdominal operations in patients with cirrhosis: Still a major surgical challengeSurgery, 1997
- Morbid Prognostic Features in Patients With Chronic Liver Failure Undergoing Nonhepatic SurgeryArchives of Surgery, 1997
- The surgical risk of colectomy in patients with cirrhosisDiseases of the Colon & Rectum, 1987