Faculty Collaboration Database

Adverse outcomes in patients with chronic liver disease undergoing colorectal surgery. Ann Surg 2010 Aug;252(2):345-50

Date

07/14/2010

Pubmed ID

20622652

DOI

10.1097/SLA.0b013e3181e982d6

Scopus ID

2-s2.0-77955172758 (requires institutional sign-in at Scopus site)   38 Citations

Abstract

OBJECTIVE: We sought to use a multi-institutional, prospective, clinical database to better understand adverse outcomes in chronic liver disease (CLD) patients undergoing colorectal surgery.

BACKGROUND: CLD confers significant perioperative risk. However, there are little population-based data available for prognostication and risk stratification in these patients.

METHODS: We used data from the 2005-2007 American College of Surgeons National Surgical Quality Improvement Project to study 30,927 patients undergoing colorectal resections. We first identified patients with CLD (n = 1565) with any of the following clinical characteristics: ascites, esophageal varices, or total bilirubin greater than 2 mg/dL. Postoperative complications and mortality rates were then compared between CLD and non-CLD patients.

RESULTS: CLD patients have a nearly 6.5-fold increased risk of mortality following colorectal operations (Relative Risk [RR], 6.53; 3.2% in non-CLD group versus 21.5% in CLD group). Patients with CLD also had significantly higher major complication rates (RR, 2.72; 15.4% vs. 41.9%, respectively). The failure to rescue rate (ie, proportion of deaths following major complications) was also markedly higher in patients with CLD (RR, 2.27; 15.1% vs. 34.2%, respectively). Furthermore, stratification of CLD patients by Model for End-stage Liver Disease (MELD) score demonstrated significantly higher rates of complications (RR, 2.41; 2.31-2.51), failure to rescue (RR, 2.62; 2.35-2.90), and mortality (RR, 8.92; 8.11-9.78) in CLD patients with MELD > or =15 compared with CLD patients with MELD <15.

CONCLUSIONS: Colorectal surgery in CLD patients is associated with significant morbidity and mortality. Furthermore, those who develop major complications have a significantly higher risk of death compared to non-CLD. These very high risks should be discussed at length with patients prior to undertaking major surgical procedures.

Author List

Ghaferi AA, Mathur AK, Sonnenday CJ, Dimick JB

Author

Amir Ghaferi MD President, Phys Enterprise & SAD Clinical Affairs in the Medical College Physicians Administration department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Chi-Square Distribution
Chronic Disease
Colorectal Surgery
Female
Humans
Liver Diseases
Logistic Models
Male
Middle Aged
Postoperative Complications
Prognosis
Prospective Studies
Registries
Risk Factors