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Ann Surg. 2010 Aug;252(2):345-50. doi: 10.1097/SLA.0b013e3181e982d6.

Adverse outcomes in patients with chronic liver disease undergoing colorectal surgery.

Author information

1
Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA. aghaferi@umich.edu

Abstract

OBJECTIVE:

We sought to use a multi-institutional, prospective, clinical database to better understand adverse outcomes in chronic liver disease (CLD) patients undergoing colorectal surgery.

BACKGROUND:

CLD confers significant perioperative risk. However, there are little population-based data available for prognostication and risk stratification in these patients.

METHODS:

We used data from the 2005-2007 American College of Surgeons National Surgical Quality Improvement Project to study 30,927 patients undergoing colorectal resections. We first identified patients with CLD (n = 1565) with any of the following clinical characteristics: ascites, esophageal varices, or total bilirubin greater than 2 mg/dL. Postoperative complications and mortality rates were then compared between CLD and non-CLD patients.

RESULTS:

CLD patients have a nearly 6.5-fold increased risk of mortality following colorectal operations (Relative Risk [RR], 6.53; 3.2% in non-CLD group versus 21.5% in CLD group). Patients with CLD also had significantly higher major complication rates (RR, 2.72; 15.4% vs. 41.9%, respectively). The failure to rescue rate (ie, proportion of deaths following major complications) was also markedly higher in patients with CLD (RR, 2.27; 15.1% vs. 34.2%, respectively). Furthermore, stratification of CLD patients by Model for End-stage Liver Disease (MELD) score demonstrated significantly higher rates of complications (RR, 2.41; 2.31-2.51), failure to rescue (RR, 2.62; 2.35-2.90), and mortality (RR, 8.92; 8.11-9.78) in CLD patients with MELD > or =15 compared with CLD patients with MELD <15.

CONCLUSIONS:

Colorectal surgery in CLD patients is associated with significant morbidity and mortality. Furthermore, those who develop major complications have a significantly higher risk of death compared to non-CLD. These very high risks should be discussed at length with patients prior to undertaking major surgical procedures.

PMID:
20622652
DOI:
10.1097/SLA.0b013e3181e982d6
[Indexed for MEDLINE]

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