RISK OF NONSHUNT ABDOMINAL OPERATION IN THE PATIENT WITH CIRRHOSIS

BACKGROUND: The hazards of operative treatment for variceal hemorrhage and intractable ascites in patients with cirrhosis are well known. Mu ch less information is available on the morbidity and mortality in the se patients after abdominal operations not directly related to the seq uelae of portal hypertension. STUDY DESIGN: We reviewed the records of 77 consecutive histologically proved cases of cirrhosis in patients u ndergoing 85 general surgical, abdominal procedures during a ten year period. Logistic regression analysis was done on 32 preoperative and i ntraoperative variables with relation to postoperative outcome. RESULT S: There were 47 men and 30 women, with a mean age of 61 years (range of 28 to 86 years). The 30-day mortality rate was 18 percent (15 of 77 patients). Emergent operation was associated with a mortality rate of 32 percent (11 of 35 patients) compared with 8 percent (four of 50 pa tients) after elective procedures (p<0.05). Extensive complications oc curred in 28 percent of patients (24 patients; 14 percent after electi ve operative treatment and 49 percent after emergent procedures). The mortality rate was greatest after gastric procedures (38 percent). Oth er factors of statistical significance (p<0.05) associated with poor p ostoperative outcome included cachexia, preoperative transfusion of fr esh frozen plasma, and intraoperative platelet transfusion. Surprising ly, operative blood loss, presence of ascites, and operative time were not associated with increased complications or death. CONCLUSIONS: We conclude that elective, nonshunt abdominal operations can be performe d with acceptable morbidity and mortality rates in selected patients w ith cirrhosis.