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

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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.

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

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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., Frye, C. C., Maluccio, M. A., Kubal, C. A., & 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