Key result
Non-cirrhotic chronic liver disease increased major post-operative complications versus controls (11.8% vs 6.1%, P=0.051), while cirrhosis further increased complications to 32.5% (P<0.001).
Why the study?
Does chronic liver disease increase the risk of post-operative morbidity and mortality in patients undergoing surgery?
Cohort (n=757)
Does chronic liver disease increase the risk of post-operative morbidity and mortality in patients undergoing surgery?
Absolute Event Rate: 11.8% vs 6.1%
p-value: p=0.051
Chronic liver disease, particularly cirrhosis, significantly increases the risk of post-operative morbidity and mortality, dependent on the degree of hepatic decompensation and type of surgery.
Supports heightened perioperative vigilance in chronic liver disease; extends cirrhosis data to non-cirrhotic cases but leaves causality open in observational cohorts.
BACKGROUND & AIMS: Chronic liver disease is a common comorbidity in surgery. To assess post-operative morbidity and mortality in relation to progression of chronic liver disease and to identify the risk factors. METHODS: Six hundred and nine consecutive patients with chronic liver disease who underwent surgery were classified into two groups: non-cirrhotic (n = 363) and cirrhotic (n = 246). Randomly selected patients without underlying liver disease who underwent surgery were used as control group (n = 148). RESULTS: The occurrence of major post-operative complications was higher in the non-cirrhotic group than in the control group (11.8% vs. 6.1%, P = 0.051); age, type of surgery and serum albumin level were independent predictors for post-operative morbidity. The frequency of significant post-operative liver damage (14.9% vs. 12.2%, P = 0.920) and mortality (0.6% vs. 0.7%, P = 0.871) did not differ between the two groups. The cirrhotic group had markedly higher incidences of post-operative mortality (10.2%), major complications (32.5%) and significant liver damage (43.1%) than the control and non-cirrhotic groups (all P < 0.001). Type of surgery, Child-Pugh score and model for end-stage liver disease score were independently associated with post-operative morbidity and mortality in patients with cirrhosis. Specific data regarding post-operative morbidity and mortality were presented according to progression of liver disease and type of surgery. CONCLUSION: Non-cirrhotic chronic liver diseases were associated with higher risk of post-operative morbidity, particularly in cases of major surgery, older age and hypoalbuminaemia. Cirrhosis further increased the risk, even death, depending on degree of hepatic decompensation and type of surgery.
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Kim et al. (2014) conducted a cohort in Chronic liver disease (n=757). Chronic liver disease (non-cirrhotic) vs. No underlying liver disease was evaluated on Major post-operative complications (p=0.051). Non-cirrhotic chronic liver disease increased major post-operative complications versus controls (11.8% vs 6.1%, P=0.051), while cirrhosis further increased complications to 32.5% (P<0.001).
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