Risk factors of surgical treatment in patients with liver cirrhosis

Close metadata

OBJECTIVE

To optimize selection of patient for surgical treatment of comorbidities and complications of liver cirrhosis (LC) via analysis of perioperative risk factors.

MATERIAL AND METHODS

There were 610 patients with LC and comorbidities who underwent surgical treatment between 2015 and 2021 at the Regional Clinical Hospital No. 2. Thirty (4.9%) patients died. We analyzed Child-Pugh and MELD scores, Mayo Postoperative Surgical Risk Score and Charlson comorbidity index to predict postoperative mortality.

RESULTS

Perioperative risk in patients with LC depends on the type of surgery, degree of surgical invasiveness, liver function, and severity of LC-associated complications.

CONCLUSION

A thorough preoperative assessment of patients and adequate perioperative management are required to reduce the risk of mortality.

liver cirrhosis, surgical treatment, risk factors.

Authors:

Durleshter V.M.

Regional Clinical Hospital No. 2;
Kuban State Medical University

ORCID: 0000-0002-7420-0553

Korochanskaya N.V.

Kuban State Medical University;
Regional Clinical Hospital No. 2

Murashko D.S.

Kuban State Medical University;
Regional Clinical Hospital No. 2

Basenko M.A.

Kuban State Medical University

Received:

18.05.2021

Accepted:

12.06.2021

List of references:

European Association for the Study of the Liver, Collaborators, Angeli P, Bernardi M, Villanueva C, Francoz C, et al. EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. J Hepatol. 2018;69:406-460.
Northup PG, Friedman LS, Kamath PS. AGA clinical practice update on surgical risk assessment and perioperative management in cirrhosis: expert review. Clin Gastroenterol Hepatol. 2019;17:595-606. PMID: 30273751. https://doi.org/10.1016/j.cgh.2018.09.043
Mahmud N, Fricker Z, Serper M, Kaplan DE, Rothstein KD, Goldberg DS. In-Hospital mortality varies by procedure type among cirrhosis surgery admis-sions. Liver Int. 2019;39:1394-1399. PMID: 31141306. https://doi.org/10.1111/liv.14156
Peng Y, Qi X, Guo X. Child-Pugh versus MELD score for the assessmentof prognosis in liver cirrhosis: a systematic review and meta-analysis ofobservational studies. Medicine. 2016;95:e2877. https://doi.org/10.1097/MD.0000000000002877
Chen C-C, Chen S-W, Tu P-H, Huang Y-C, Liu Z-H, Yi-Chou Wang A, et al. Outcomes of chronic subdural hematoma in patients with liver cirrhosis. J Neu-rosurg. 2018;130:302-311. PMID:29393757. https://doi.org/10.3171/2017.8.JNS171103
Lopez-Delgado JC, Ballus J, Esteve F, Betancur-Zambrano NL, Corral-Velez V,Ma˜nez R, et al. Outcomes of abdominal surgery in patients with liver cirrhosis. World J Gastroenterol. 2016;22:2657-2667. PMID: 26973406. https://doi.org/10.3748/wjg.v22.i9.2657
Mack MJ, Leon MB, Smith CR, Miller DC, Moses JW, Tuzcu EM, et al. 5-yearoutcomes of transcatheter aortic valve replacement or surgical aortic valvereplacement for high surgical risk patients with aortic stenosis (PARTNER 1): A randomised controlled trial. Lancet. 2015;385: 2477-2484. https://doi.org/10.1016/S0140-6736(15)60308-7
Anisimov AYu, Vertkin AL, Devyatov AV, Dzidzava II, Zhigalova SB, Zatevakhin II, Kitsenko EA, Kotiv BN, Lebezev VM, Lopatkina TN, Maevskaya MV, Manukyan GV, Monakhov DV, Nazyrov FG, Ogurtsov PP, Pavlov ChS, Prudkov MI, Khoronko YuV, Tsitsiashvili MSh, Zhao AV, Shertsinger AG, Shipovsky VN. Clinic manual of bleeding treatment from gastric and esophageal varicose vein dilatation (Adopted at Russian agreement conference on adoption of National clinic recommendations “Bleeding from upper parts of gastro-intestinal tract”, Voronezh, June 5-6, 2014. Russian Surgical Society, Association of Hepatopancreatobiliary Surgeons of CIS Countries). M.: Voronezh; 2014. (In Russ.).
Ivashkin VT, Maevskaya MV, Pavlov ChS, Fedosina EA, Bessonova EN, Pirogova IYu, Garbuzenko DV. Clinic recommendations of Russian society of hepatic study of Russian gastroenterological Association of hepatic cirrhosis complications treatment. Rossijskij zhurnal gastroenterologii, gepatologii, koloproktologii. 2016;26(4):71-102. (In Russ.).
Zabolotskikh IB, Gromova EG, Lebedinskii KM. Perioperated tactics of patients with accompanied hepatic diseases: Clinic recommendations. SPb; 2017. (In Russ.).
Garcia-Tsao G, Abraldes JG, Berzigotti A, et al. Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for thethe study of liver diseases. Hepatology. 2017;65:310-335.
Sousa M, Fernandes S, Proença L, Silva AP, Leite S, Silva J, Ponte A, Rodrigues J, Silva JC, Carvalho J. The Baveno VI criteria for predicting esophageal varices: validation in real life practice. Rev Esp Enferm Dig. 2017;109(10):704-707. PMID: 28776387. https://doi.org/10.17235/reed.2017.5052/2017
Teh SH, Nagorney DM, Stevens SR, et al. Risk factors for mortality after surgery in patients with cirrhosis. Gastroenterology. 2007;132:1261-1269.
https://www.mayoclinic.org/medicalprofessionals/model-end-stage-liver-disease/postoperativemortality-risk-patients-cirrhosis
Northup PG, Wanamaker RC, Lee VD, et al. Model for End-Stage Liver Disease (MELD) predicts nontransplant surgical mortality in patients with cirrhosis. Ann Surg. 2005;242:244-251.
Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis. 1987;40:373-383.
Durand F, Valla D. Assessment of prognosis of cirrhosis. Semin Liver Dis. 2008;28:110-122.
Freeman RB Jr, Wiesner RH, Harper A, et al. The new liver allocation system: moving toward evidence-based transplantation policy. Liver Transpl. 2002;8:851-858.
Befeler AS, Palmer DE, Hoffman M, Longo W, Solomon H, Di Bisceglie AM.The safety of intra-abdominal surgery in patients with cirrhosis: model forend-stage liver disease score is superior to Child-Turcotte-Pugh classificationin predicting outcome. Arch Surg. 2005;140:650-654. discussion 655. PMID: 16027329. https://doi.org/10.1001/archsurg.140.7.650
Peng Y, Qi X, Guo X. Child-Pugh versus MELD score for the assessmentof prognosis in liver cirrhosis: a systematic review and meta-analysis ofobservational studies. Medicine. 2016;95:e2877. PMID: 26937922. https://doi.org/10.1097/MD.0000000000002877
Kim SY, Yim HJ, Park SM, Kim JH, Jung SW, Kim JH, et al. Validation of a Mayopost-operative mortality risk prediction model in Korean cirrhotic patients. Liver Int. 2011;31:222-228. PMID: 21134111. https://doi.org/10.1111/j.1478-3231.2010.02419.x
Mahmud N, Fricker Z, Serper M, Kaplan DE, Rothstein KD, Goldberg DS. In-Hospital mortality varies by procedure type among cirrhosis surgery admis-sions. Liver Int. 2019;39:1394-1399. PMID:31141306. https://doi.org/10.1111/liv.14156
Lopez-Delgado JC, Ballus J, Esteve F, Betancur-Zambrano NL, Corral-Velez V, Mañez R, et al. Outcomes of abdominal surgery in patients with liver cirrhosis. World J Gastroenterol. 2016;22:2657-2667. PMID: 26973406. https://doi.org/10.3748/wjg.v22.i9.2657
Gibbs J, Cull W, Henderson W, Daley J, Hur K, Khuri SF. Preoperative serum albumin level as a predictor of operative mortality and morbidity: results from the National VA Surgical Risk Study. Arch Surg. 1999;134:36-42.

Close metadata