Doberneck et al identified risk factors for postoperative mortality in patients with nonbleeding cirrhosis. This can help identify patients who should defer surgery or who may require more aggressive management. The authors are from the University of New Mexico in Albuquerque.
Operative procedures included abdominal, thoracic and orthopedic procedures.
Most common causes of death:
(1) bleeding
(2) liver failure
(3) sepsis
Parameters associated with postoperative mortality:
(1) ascites
(2) serum total bilirubin
(3) serum alkaline phosphatase
(4) increase in prothrombin time (PT)
(5) increase in activated partial thromboplastin time (aPTT)
(6) operation timing
(7) organ target
(8) blood loss
(9) postoperative complications
|
Parameter |
Finding |
Points |
|
ascites |
absent |
0 |
|
|
present |
1 |
|
serum total bilirubin |
< 3.5 mg/dL |
0 |
|
|
>= 3.5 mg/dL |
1 |
|
serum alkaline phosphatase |
< 70 IU/L |
0 |
|
|
>= 70 IU/L |
1 |
|
(patient PT) - (upper limit reference range) |
<= 2.0 seconds |
0 |
|
|
> 2.0 seconds |
1 |
|
(patient aPTT) - (upper limit reference range) |
<= 2.0 seconds |
0 |
|
|
> 2.0 seconds |
1 |
|
operation timing |
elective |
0 |
|
|
emergency |
1 |
|
organ target |
non-alimentary |
0 |
|
|
alimentary |
1 |
|
blood loss |
< 1,000 mL |
0 |
|
|
>= 1,000 mL |
1 |
|
postoperative complications |
no |
0 |
|
|
yes |
1 |
where:
• The authors used "<" and ">" without indicating "=" for bilirubin, alkaline phosphatase, PT, aPTT, and blood loss.
• It appears that alimentary includes liver, gallbladder, and pancreas but not a porto-caval shunt.
number of risk factors present =
= SUM(points for all 9 parameters)
Interpretation:
• minimum number: 0
• maximum number: 9
• The higher the number of risk factors the greater the mortality risk.
|
Number |
Mortality Rate |
|
0 or 1 |
5.1% |
|
2 or 3 |
19.4% |
|
4 or 5 |
33.3% |
|
>= 6 |
66.7% |
after Table III, page 308
Limitations:
• The study was performed prior to development of laparoscopic techniques.
Specialty: Gastroenterology, Surgery, general, Surgery, orthopedic
ICD-10: ,
