pmc logo image
Logo of annsurgJournal URL: http://www.annalsofsurgery.com

Formats:

Ann Surg. 1984 June; 199(6): 648–655.
PMCID: PMC1353440
Clarification of risk factors for abdominal operations in patients with hepatic cirrhosis.
R N Garrison, H M Cryer, D A Howard, and H C Polk, Jr
Abstract
Celiotomy in cirrhotic patients is reported to bear a high risk of operative morbidity and mortality. We reviewed 100 consecutive, cirrhotic patients who underwent nonshunt celiotomy. Thirty patients died and major complications occurred in another 30 patients. Hospital mortality rate was 21% in 39 biliary operations, 35% in 26 procedures for peptic ulcer disease, and 55% in nine colectomies . Fifty-two variables were compared between survivors without complication, survivors with complications, and nonsurvivors. A computer-generated, multivariant discriminant analysis yielded an equation predictive of survival. Utilizing coagulation parameters, presence of active infection, and serum albumin, the equation predicted survival with 89% accuracy. In a similar fashion, amount of operative transfusions, absence of postoperative ascites, pulmonary failure, gastrointestinal bleeding, and culture-positive urine predicted survival with 100% accuracy. We conclude that celiotomy in the cirrhotic patient is truly associated with very high morbidity and mortality, and preoperative assessment can predict survival with 89% accuracy.
Full text
Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.3M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
  • Jackson FC, Christophersen EB, Peternel WW, Kirimli B. Preoperative management of patients with liver disease. Surg Clin North Am. 1968 Aug;48(4):907–930. [PubMed]
  • Aranha GV, Sontag SJ, Greenlee HB. Cholecystectomy in cirrhotic patients: a formidable operation. Am J Surg. 1982 Jan;143(1):55–60. [PubMed]
  • CAYER D, SOHMER MF. Surgery in patients with cirrhosis. AMA Arch Surg. 1955 Dec;71(6):828–838. [PubMed]
  • Cello JP, Deveney KE, Trunkey DD, Heilbron DC, Stoney RJ, Ehrenfeld WK, Way LW. Factors influencing survival after therapeutic shunts. Results of a discriminant function and linear logistic regressions analysis. Am J Surg. 1981 Feb;141(2):257–265. [PubMed]
  • Doberneck RC, Sterling WA, Jr, Allison DC. Morbidity and mortality after operation in nonbleeding cirrhotic patients. Am J Surg. 1983 Sep;146(3):306–309. [PubMed]
  • Schwartz SI. Biliary tract surgery and cirrhosis: a critical combination. Surgery. 1981 Oct;90(4):577–583. [PubMed]
  • Simert G, Persson T, Vang J. Factors predicing survival after portacaval shunt: a multiple linear regression analysis. Ann Surg. 1978 Feb;187(2):174–178. [PubMed]
  • Wirthlin LS, Van Urk H, Malt RB, Malt RA. Predictors of surgical mortality in patients with cirrhosis and nonvariceal gastroduodenal bleeding. Surg Gynecol Obstet. 1974 Jul;139(1):65–68. [PubMed]
  • LINTON RR. The selection of patients for portacaval shunts, with a summary of the results in 61 cases. Ann Surg. 1951 Sep;134(3):433–443. [PubMed]
  • MCDERMOTT WV., Jr The double portacaval shunt in the treatment of cirrhotic ascites. Surg Gynecol Obstet. 1960 Apr;110:457–469. [PubMed]
  • Stone HH. Preoperative and postoperative care. Surg Clin North Am. 1977 Apr;57(2):409–419. [PubMed]
  • Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg. 1973 Aug;60(8):646–649. [PubMed]
  • Irvin GL, 3rd, Zeppa R. Predicted survival in peptic ulcer patients based on computer analysis of preoperative variables. Ann Surg. 1976 May;183(5):594–598. [PubMed]