Neeff et al evaluated patients with hepatic cirrhosis who underwent abdominal surgery. A patient with cirrhosis who undergoes abdominal surgery is at increased risk for mortality. The authors are from the University of Freiburg in Germany.
Patient selection: abdominal surgery in a patient with hepatic cirrhosis
Mortality rates: 30-day 20%; 90-day 30%
Risk factors for 30-day mortality:
(1) MELD (>= 20)
(2) Child-Turcotte-Pugh stage (stage C)
(3) ASA score (4 or 5)
(4) increased serum creatinine (>= 1.5 mg/dL)
(5) emergency surgery
(6) intraoperative transfusion
Risk factors for 90-day mortality:
(1) MELD (>= 20)
(2) Child-Turcotte-Pugh stage (stage C)
(3) ASA score (4 or 5)
(4) emergency surgery
(5) major surgery
(6) thrombocytopenia (<= 100,000 per µL)
(7) hyponatremia (< 130 mmol/L)
Other factors affecting longer term mortality:
(1) underlying malignancy
(2) Child-Turcotte-Pugh stage (C > B > A)
(3) MELD score (> 30, 20-29, 10-19 and < 10)
