Specialized care improves outcomes for patients with cirrhosis who require general surgical operations

Joshua K. Kays, Daniel P. Milgrom, James R. Butler, Tiffany W. Liang, Nakul P. Valsangkar, Brandon Wojcik, C. Corbin Frye, Mary A. Maluccio, Chandrashekhar A. Kubal, Leonidas G. Koniaris

Research output: Contribution to journalArticle

Abstract

Background General surgical operations on patients with cirrhosis have historically been associated with high morbidity and mortality rates. This study examines a contemporary series of patients with cirrhosis undergoing general surgical procedures. Methods A retrospective evaluation of 358 cirrhotic patients undergoing general surgical operations at a single institution between 2004-2015 was performed. Thirty- and 90-day mortality along with complications and subsequent transplantation rates were examined. Results 358 cirrhotic patients were identified. The majority were Child-Turcotte-Pugh class (CTP) A (55.9%) followed by class B (32.4%) and class C (11.7%). Mean MELD score differed significantly between the groups (8.7 vs. 12.1 vs. 20.1; p<0.001). The most common operations were herniorrhaphy (29.9%), cholecystectomy (19.3%), and liver resection (14.5%). The majority of cases were performed semi-electively (68.4%), however, within the CTP C patients most cases were performed emergently (73.8%). Thirty and 90-day mortality for all patients were 5% and 6%, respectively. Mortality rates increased from CTP A to CTP C (30 day: 3.0% vs. 5.2% vs. 14.3%; p = 0.01; 90 day: 4.5% vs. 6.9% vs. 16.7%; p = 0.016). Additionally, 30-day mortality (12.8% vs. 2.3%; p<0.001), 90 day mortality (16.0% vs. 3.4%; p<0.001) were higher for emergent compared to elective cases. A total of 13 (3.6%) patients underwent transplantation . 90 days from surgery. No elective cases resulted in an urgent transplantation. Conclusion Performing general surgical operations on cirrhotic patients carries a significant morbidity and mortality. This contemporary series from a specialized liver center demonstrates improved outcomes compared to historical series. These data strongly support early referral of cirrhotic patients needing general surgical operation to centers with liver expertise to minimize morbidity and mortality.

Original languageEnglish (US)
Article numbere0223454
JournalPLoS ONE
Volume14
Issue number10
DOIs
StatePublished - Jan 1 2019

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Liver
Fibrosis
surgery
Mortality
Surgery
morbidity
Transplantation
Morbidity
liver
Herniorrhaphy
Cholecystectomy
resection
Ambulatory Surgical Procedures
Referral and Consultation

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)
  • General

Cite this

Kays, J. K., Milgrom, D. P., Butler, J. R., Liang, T. W., Valsangkar, N. P., Wojcik, B., ... Koniaris, L. G. (2019). Specialized care improves outcomes for patients with cirrhosis who require general surgical operations. PLoS ONE, 14(10), [e0223454]. https://doi.org/10.1371/journal.pone.0223454

Specialized care improves outcomes for patients with cirrhosis who require general surgical operations. / Kays, Joshua K.; Milgrom, Daniel P.; Butler, James R.; Liang, Tiffany W.; Valsangkar, Nakul P.; Wojcik, Brandon; Frye, C. Corbin; Maluccio, Mary A.; Kubal, Chandrashekhar A.; Koniaris, Leonidas G.

In: PLoS ONE, Vol. 14, No. 10, e0223454, 01.01.2019.

Research output: Contribution to journalArticle

Kays, JK, Milgrom, DP, Butler, JR, Liang, TW, Valsangkar, NP, Wojcik, B, Frye, CC, Maluccio, MA, Kubal, CA & Koniaris, LG 2019, 'Specialized care improves outcomes for patients with cirrhosis who require general surgical operations', PLoS ONE, vol. 14, no. 10, e0223454. https://doi.org/10.1371/journal.pone.0223454
Kays JK, Milgrom DP, Butler JR, Liang TW, Valsangkar NP, Wojcik B et al. Specialized care improves outcomes for patients with cirrhosis who require general surgical operations. PLoS ONE. 2019 Jan 1;14(10). e0223454. https://doi.org/10.1371/journal.pone.0223454
Kays, Joshua K. ; Milgrom, Daniel P. ; Butler, James R. ; Liang, Tiffany W. ; Valsangkar, Nakul P. ; Wojcik, Brandon ; Frye, C. Corbin ; Maluccio, Mary A. ; Kubal, Chandrashekhar A. ; Koniaris, Leonidas G. / Specialized care improves outcomes for patients with cirrhosis who require general surgical operations. In: PLoS ONE. 2019 ; Vol. 14, No. 10.
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abstract = "Background General surgical operations on patients with cirrhosis have historically been associated with high morbidity and mortality rates. This study examines a contemporary series of patients with cirrhosis undergoing general surgical procedures. Methods A retrospective evaluation of 358 cirrhotic patients undergoing general surgical operations at a single institution between 2004-2015 was performed. Thirty- and 90-day mortality along with complications and subsequent transplantation rates were examined. Results 358 cirrhotic patients were identified. The majority were Child-Turcotte-Pugh class (CTP) A (55.9{\%}) followed by class B (32.4{\%}) and class C (11.7{\%}). Mean MELD score differed significantly between the groups (8.7 vs. 12.1 vs. 20.1; p<0.001). The most common operations were herniorrhaphy (29.9{\%}), cholecystectomy (19.3{\%}), and liver resection (14.5{\%}). The majority of cases were performed semi-electively (68.4{\%}), however, within the CTP C patients most cases were performed emergently (73.8{\%}). Thirty and 90-day mortality for all patients were 5{\%} and 6{\%}, respectively. Mortality rates increased from CTP A to CTP C (30 day: 3.0{\%} vs. 5.2{\%} vs. 14.3{\%}; p = 0.01; 90 day: 4.5{\%} vs. 6.9{\%} vs. 16.7{\%}; p = 0.016). Additionally, 30-day mortality (12.8{\%} vs. 2.3{\%}; p<0.001), 90 day mortality (16.0{\%} vs. 3.4{\%}; p<0.001) were higher for emergent compared to elective cases. A total of 13 (3.6{\%}) patients underwent transplantation . 90 days from surgery. No elective cases resulted in an urgent transplantation. Conclusion Performing general surgical operations on cirrhotic patients carries a significant morbidity and mortality. This contemporary series from a specialized liver center demonstrates improved outcomes compared to historical series. These data strongly support early referral of cirrhotic patients needing general surgical operation to centers with liver expertise to minimize morbidity and mortality.",
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AU - Kays, Joshua K.

AU - Milgrom, Daniel P.

AU - Butler, James R.

AU - Liang, Tiffany W.

AU - Valsangkar, Nakul P.

AU - Wojcik, Brandon

AU - Frye, C. Corbin

AU - Maluccio, Mary A.

AU - Kubal, Chandrashekhar A.

AU - Koniaris, Leonidas G.

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N2 - Background General surgical operations on patients with cirrhosis have historically been associated with high morbidity and mortality rates. This study examines a contemporary series of patients with cirrhosis undergoing general surgical procedures. Methods A retrospective evaluation of 358 cirrhotic patients undergoing general surgical operations at a single institution between 2004-2015 was performed. Thirty- and 90-day mortality along with complications and subsequent transplantation rates were examined. Results 358 cirrhotic patients were identified. The majority were Child-Turcotte-Pugh class (CTP) A (55.9%) followed by class B (32.4%) and class C (11.7%). Mean MELD score differed significantly between the groups (8.7 vs. 12.1 vs. 20.1; p<0.001). The most common operations were herniorrhaphy (29.9%), cholecystectomy (19.3%), and liver resection (14.5%). The majority of cases were performed semi-electively (68.4%), however, within the CTP C patients most cases were performed emergently (73.8%). Thirty and 90-day mortality for all patients were 5% and 6%, respectively. Mortality rates increased from CTP A to CTP C (30 day: 3.0% vs. 5.2% vs. 14.3%; p = 0.01; 90 day: 4.5% vs. 6.9% vs. 16.7%; p = 0.016). Additionally, 30-day mortality (12.8% vs. 2.3%; p<0.001), 90 day mortality (16.0% vs. 3.4%; p<0.001) were higher for emergent compared to elective cases. A total of 13 (3.6%) patients underwent transplantation . 90 days from surgery. No elective cases resulted in an urgent transplantation. Conclusion Performing general surgical operations on cirrhotic patients carries a significant morbidity and mortality. This contemporary series from a specialized liver center demonstrates improved outcomes compared to historical series. These data strongly support early referral of cirrhotic patients needing general surgical operation to centers with liver expertise to minimize morbidity and mortality.

AB - Background General surgical operations on patients with cirrhosis have historically been associated with high morbidity and mortality rates. This study examines a contemporary series of patients with cirrhosis undergoing general surgical procedures. Methods A retrospective evaluation of 358 cirrhotic patients undergoing general surgical operations at a single institution between 2004-2015 was performed. Thirty- and 90-day mortality along with complications and subsequent transplantation rates were examined. Results 358 cirrhotic patients were identified. The majority were Child-Turcotte-Pugh class (CTP) A (55.9%) followed by class B (32.4%) and class C (11.7%). Mean MELD score differed significantly between the groups (8.7 vs. 12.1 vs. 20.1; p<0.001). The most common operations were herniorrhaphy (29.9%), cholecystectomy (19.3%), and liver resection (14.5%). The majority of cases were performed semi-electively (68.4%), however, within the CTP C patients most cases were performed emergently (73.8%). Thirty and 90-day mortality for all patients were 5% and 6%, respectively. Mortality rates increased from CTP A to CTP C (30 day: 3.0% vs. 5.2% vs. 14.3%; p = 0.01; 90 day: 4.5% vs. 6.9% vs. 16.7%; p = 0.016). Additionally, 30-day mortality (12.8% vs. 2.3%; p<0.001), 90 day mortality (16.0% vs. 3.4%; p<0.001) were higher for emergent compared to elective cases. A total of 13 (3.6%) patients underwent transplantation . 90 days from surgery. No elective cases resulted in an urgent transplantation. Conclusion Performing general surgical operations on cirrhotic patients carries a significant morbidity and mortality. This contemporary series from a specialized liver center demonstrates improved outcomes compared to historical series. These data strongly support early referral of cirrhotic patients needing general surgical operation to centers with liver expertise to minimize morbidity and mortality.

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