Original article—liver, pancreas, and biliary tractFactors That Predict Outcome of Abdominal Operations in Patients With Advanced Cirrhosis
Section snippets
Patient Acquisition
After approval by the Mount Sinai School of Medicine Institutional Review Board, a retrospective chart review was performed of 100 cirrhotic patients who underwent general surgical procedures at The Mount Sinai Medical Center from January 1, 2002 to December 31, 2008. Patients were identified from an administrative database by cross-matching International Classification of Diseases, 9th revision codes for cirrhosis (571.0, 571.2, 571.5, 571.6) with Current Procedural Terminology procedure codes
Population Characteristics and Outcome
One hundred cirrhotic patients qualified for the study. Mean patient age was 58.1 years, and 58% of patients were male. Twenty-eight patients had documented history of esophageal varices, 8 of spontaneous bacterial peritonitis, and 8 patients had a portosytemic shunt placed before operative procedure. Operative procedures consisted of 47 herniorrhaphies (35 umbilical and 12 ventral), 26 cholecystectomies, 17 colectomies, 3 appendectomies, 2 pancreaticoduodenectomies, and 5 other abdominal
Discussion
Operative decisions concerning cirrhotic patients are challenging. Identifying preoperative factors that might help determine appropriate operative candidates, the optimal timing of operative intervention, is that potentially reduce postoperative complications are of great importance. Our study has identified multiple factors, in addition to those already reported by current literature, that strongly influence postoperative course.
Perhaps the most significant finding our data demonstrated was
Conclusions
In summary, preoperative albumin strongly correlated with outcome in patients with MELD ≥15 and should be considered a criterion guiding operative decisions. Patients with MELD ≥15 and serum albumin levels <2.5 mg/dL appear to be poor operative candidates, and adverse outcomes should be anticipated. Conversely, this study identified a subset of patients with advanced cirrhosis and preoperative serum albumin >2.5 mg/dL who might be suitable for operative procedures with better than anticipated
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This article has an accompanying continuing medical education activity on page e58. Learning Objectives—At the end of this activity, the learner should be able to define the expected frequency of morbidity and mortality of abdominal operations in patients with advanced cirrhosis, and how best to predict such outcomes.
Conflicts of interest The authors disclose no conflicts.