TY - JOUR
T1 - The impact of cirrhosis and portal hypertension on mortality following colorectal surgery
T2 - A nationwide, population-based study
AU - Nguyen, Geoffrey C.
AU - Correia, Adriano J.
AU - Thuluvath, Paul J.
PY - 2009/8
Y1 - 2009/8
N2 - PURPOSE: Population-based data on outcomes associated with colorectal procedures in cirrhotic patients are sparse. We sought to assess the impact of liver cirrhosis and portal hypertension on mortality following colorectal surgery. METHODS: We queried patients who underwent colorectal surgery in the United States in the Nationwide Inpatient Sample (1998-2005). In-hospital mortality was determined for patients with no cirrhosis, compensated cirrhotic patients, and cirrhotic patients with portal hypertension. Multivariate logistic regression analysis was used to adjust for sociodemographic and clinical covariates. RESULTS: Patients with cirrhosis and cirrhosis with portal hypertension had significantly higher in-hospital mortality than patients with no cirrhosis (14% and 29% vs. 5%, respectively, P < 0.0001). In-hospital mortality was also significantly higher for emergent and urgent colorectal procedures compared with elective procedures (9.2% vs. 1.8%, P < 0.0001). Among elective colorectal procedures, adjusted mortality was increased in cirrhotic patients (adjusted odds ratio, 3.91; 95% confidence interval, 3.12-4.90) and cirrhotic patients with portal hypertension (adjusted odds ratio, 11.3; 95% confidence interval, 8.46-15.1) compared with patients with no cirrhosis. For nonelective procedures, the adjusted odds ratio for mortality in cirrhotic patients was 2.40 (95% confidence interval, 2.07-2.79) and in cirrhotic patients with portal hypertension the adjusted odds ratio was 5.88 (95% confidence interval, 4.90-7.06). Postoperative complications were more likely in cirrhotic patients (adjusted odds ratio, 1.35; 95% confidence interval, 1.20-1.52) and cirrhotic patients with portal hypertension (adjusted odds ratio, 1.82; 95% confidence interval, 1.55-2.15) relative to patients with no cirrhosis. CONCLUSIONS: Patients with liver cirrhosis, in particular, those with portal hypertension, have increased inhospital mortality and morbidity following colorectal surgery. Strategies are needed to optimize preoperative risk.
AB - PURPOSE: Population-based data on outcomes associated with colorectal procedures in cirrhotic patients are sparse. We sought to assess the impact of liver cirrhosis and portal hypertension on mortality following colorectal surgery. METHODS: We queried patients who underwent colorectal surgery in the United States in the Nationwide Inpatient Sample (1998-2005). In-hospital mortality was determined for patients with no cirrhosis, compensated cirrhotic patients, and cirrhotic patients with portal hypertension. Multivariate logistic regression analysis was used to adjust for sociodemographic and clinical covariates. RESULTS: Patients with cirrhosis and cirrhosis with portal hypertension had significantly higher in-hospital mortality than patients with no cirrhosis (14% and 29% vs. 5%, respectively, P < 0.0001). In-hospital mortality was also significantly higher for emergent and urgent colorectal procedures compared with elective procedures (9.2% vs. 1.8%, P < 0.0001). Among elective colorectal procedures, adjusted mortality was increased in cirrhotic patients (adjusted odds ratio, 3.91; 95% confidence interval, 3.12-4.90) and cirrhotic patients with portal hypertension (adjusted odds ratio, 11.3; 95% confidence interval, 8.46-15.1) compared with patients with no cirrhosis. For nonelective procedures, the adjusted odds ratio for mortality in cirrhotic patients was 2.40 (95% confidence interval, 2.07-2.79) and in cirrhotic patients with portal hypertension the adjusted odds ratio was 5.88 (95% confidence interval, 4.90-7.06). Postoperative complications were more likely in cirrhotic patients (adjusted odds ratio, 1.35; 95% confidence interval, 1.20-1.52) and cirrhotic patients with portal hypertension (adjusted odds ratio, 1.82; 95% confidence interval, 1.55-2.15) relative to patients with no cirrhosis. CONCLUSIONS: Patients with liver cirrhosis, in particular, those with portal hypertension, have increased inhospital mortality and morbidity following colorectal surgery. Strategies are needed to optimize preoperative risk.
KW - Colorectal surgery
KW - Liver cirrhosis
KW - Mortality
KW - Portal hypertension
KW - Postoperative complication
UR - http://www.scopus.com/inward/record.url?scp=68149179406&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=68149179406&partnerID=8YFLogxK
U2 - 10.1007/DCR.0b013e3181a80dca
DO - 10.1007/DCR.0b013e3181a80dca
M3 - Article
C2 - 19617746
AN - SCOPUS:68149179406
SN - 0012-3706
VL - 52
SP - 1367
EP - 1374
JO - Diseases of the Colon and Rectum
JF - Diseases of the Colon and Rectum
IS - 8
ER -