Morbidity and mortality related to non-hepatic surgery in patients with liver cirrhosis; A systematic review

• Published in: Baillière's best practice & research. Clinical gastroenterology Vol. 26; no. 1; pp. 47 - 59
• Main Authors: de Goede, B., MSc, Klitsie, P.J., MD, Lange, J.F., MD, Professor, Metselaar, H.J., MD, Professor, Kazemier, G., MD, Professor
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.02.2012; Elsevier Limited
• Subjects: Gastroenterology and Hepatology; Humans; Liver cirrhosis; Liver Cirrhosis - complications; Liver Cirrhosis - mortality; Morbidity; Mortality; Operative; Postoperative complications; Postoperative Complications - mortality; Severity of Illness Index; Surgical procedures; Surgical Procedures, Operative - adverse effects; Surgical Procedures, Operative - mortality; Survival Rate; Operative; Surgical procedures; Liver cirrhosis; Mortality; Postoperative complications; Morbidity
• ISSN: 1521-6918; 1532-1916
• DOI: 10.1016/j.bpg.2012.01.010

Background The aim of this study is to review systematically morbidity and mortality after non-hepatic surgery in patients with liver cirrhosis. Methods Comprehensive searches were conducted in PubMed, Embase and the Cochrane Library for articles using the words: liver failure, hepatic insufficiency, liver cirrhosis, cirrhosis, cirrhotic, surgical procedures, operative complications, operative mortality, postoperative complications, surgical complication, surgical risk, hernia. Results Forty-six articles were selected from 5247 included after the initial search. Level of evidence provided in the articles varied greatly. Non-hepatic surgery of patients with cirrhosis resulted in increased postoperative morbidity and mortality compared to similar surgery for non-cirrhotic patients. Cholecystectomy and umbilical and inguinal hernia correction were associated with the lowest increased morbidity and mortality while pancreatic surgery, cardiovascular, and trauma surgery correlated with the highest. The preoperative model for end stage liver disease (MELD) and Child-Turcotte-Pugh (CTP) scores appeared to be predictive of postoperative risks. Portal hypertension and surgery in the emergency setting were associated with extra increased mortality and morbidity rates. Conclusion This systematic review of the literature showed that in patients with liver cirrhosis who undergo non-hepatic surgery, postoperative morbidity and mortality rates varied greatly depending on severity of the cirrhosis and the surgical procedure. However, the majority of procedures can be safely performed in patients with low MELD scores or CTP A cirrhosis without portal hypertension.