Specialized care improves outcomes for patients with cirrhosis who require general surgical operations

Autoři: Joshua K. Kays aff001;  Daniel P. Milgrom aff001;  James R. Butler aff001;  Tiffany W. Liang aff001;  Nakul P. Valsangkar aff001;  Brandon Wojcik aff001;  C. Corbin Frye aff001;  Mary A. Maluccio aff001;  Chandrashekhar A. Kubal aff001;  Leonidas G. Koniaris aff001
Působiště autorů: Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, United States of America aff001
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0223454



General surgical operations on patients with cirrhosis have historically been associated with high morbidity and mortality rates. This study examines a contemporary series of patients with cirrhosis undergoing general surgical procedures.


A retrospective evaluation of 358 cirrhotic patients undergoing general surgical operations at a single institution between 2004–2015 was performed. Thirty- and 90-day mortality along with complications and subsequent transplantation rates were examined.


358 cirrhotic patients were identified. The majority were Child-Turcotte-Pugh class (CTP) A (55.9%) followed by class B (32.4%) and class C (11.7%). Mean MELD score differed significantly between the groups (8.7 vs. 12.1 vs. 20.1; p<0.001). The most common operations were herniorrhaphy (29.9%), cholecystectomy (19.3%), and liver resection (14.5%). The majority of cases were performed semi-electively (68.4%), however, within the CTP C patients most cases were performed emergently (73.8%). Thirty and 90-day mortality for all patients were 5% and 6%, respectively. Mortality rates increased from CTP A to CTP C (30 day: 3.0% vs. 5.2% vs. 14.3%; p = 0.01; 90 day: 4.5% vs. 6.9% vs. 16.7%; p = 0.016). Additionally, 30-day mortality (12.8% vs. 2.3%; p<0.001), 90 day mortality (16.0% vs. 3.4%; p<0.001) were higher for emergent compared to elective cases. A total of 13 (3.6%) patients underwent transplantation ≤ 90 days from surgery. No elective cases resulted in an urgent transplantation.


Performing general surgical operations on cirrhotic patients carries a significant morbidity and mortality. This contemporary series from a specialized liver center demonstrates improved outcomes compared to historical series. These data strongly support early referral of cirrhotic patients needing general surgical operation to centers with liver expertise to minimize morbidity and mortality.

Klíčová slova:

Abdominal surgery – Cirrhosis – Death rates – Digestive system procedures – Liver diseases – Liver transplantation – Morbidity – Surgical and invasive medical procedures


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2019 Číslo 10
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