ABDOMINAL OPERATIONS IN PATIENTS WITH CIRRHOSIS - STILL A MAJOR SURGICAL CHALLENGE

Background. Hepatic transplantation and portasystemic shunts can be sa fely performed in patients with advanced liver disease, whereas other abdominal procedures appear to have a much higher mortality rate. This study reviews the outcomes of patients with cirrhosis after the full spectrum of abdominal operations. Methods. In a 12-year period, 92 pat ients diagnosed with cirrhosis required either an emergent or elective abdominal operation. There were four categories of operations: cholec ystectomy in 17 patients, hernia in 9, gastrointestinal tract in 54, a nd other procedures in 12. Fifty-five clinical, laboratory, and operat ive variables were analyzed to identify factors predictive of poor out come. Results. Coagulopathy developed in 24 patients (27%) and sepsis in 15 (16%). The mortality rate after emergent operations was 50%, com pared to 18% for elective cases (p = 0.001). Other factors that predic ted mortality included the presence of ascites (p = 0.006), encephalop athy (p = 0.002), and elevated prothrombin time (p = 0.021). The morta lity in Child's class A patients was 10%, compared to 30% in class B a nd 82% in class C patients. Conclusions. Patients with cirrhosis under going elective or emergent operations are at a significant risk of dev eloping postoperative complications leading to death. The most accurat e predictor of outcome is the patient's preoperative Child's class.