Rapid Communication
Copyright ©2008 The WJG Press and Baishideng.
World J Gastroenterol. Mar 21, 2008; 14(11): 1774-1780
Published online Mar 21, 2008. doi: 10.3748/wjg.14.1774
Table 1 Characteristics of 195 patients with cirrhosis undergoing surgical procedures under general anesthesia
Total (n =195)Death or decompensation
P valueOdds ratio
No (n = 163)Yes (n = 32)
Mean age (yr)57.1 ± 11.257.2 ± 10.956.5 ± 12.50.73
Gender, n (%)
Female79 (40.5)65 (39.9)14 (43.8)
Male116 (59.5)98 (60.1)18 (56.3)0.68
Ethnicity, n (%)
White159 (81.5)135 (82.8)24 (75.0)
African American27 (13.8)20 (12.3)7 (21.9)0.32
Other9 (4.6)8 (4.9)1 (3.1)
Etiology, n (%)
Hepatitis C73 (37.4)61 (37.2)12 (37.5)0.99
Cryptogenic51 (26.2)43 (26.4)8 (25.0)0.87
Alcohol35 (17.9)26 (16.0)9 (28.1)0.1
Hepatitis B7 (3.6)7 (4.3)0 (0.0)-
Autoimmune hepatitis5 (2.6)5 (3.1)0 (0.0)-
Primary sclerosing cholangitis5 (2.6)4 (2.5)1 (3.1)-
Primary biliary cirrhosis4 (2.1)4 (2.5)0 (0.0)-
A1 antitrypsin deficiency3 (1.5)3 (1.8)0 (0.0)-
Non-alcoholic steatohepatitis2 (1.0)2 (1.2)0 (0.0)-
Amyloidosis2 (1.0)2 (1.2)0 (0.0)-
Hemochromatosis1 (0.5)1 (0.6)0 (0.0)-
Cardiac cirrhosis1 (0.5)1 (0.6)0 (0.0)-
Cystic fibrosis1 (0.5)0 (0.0)1 (3.1)-
Unknown5 (2.6)4 (2.4)1 (3.1)-
Mean CTP score ± SD8.0 ± 1.97.8 ± 1.89.1 ± 1.90.00058
CTP class n (%)
A41 (21.0)40 (24.5)1 (3.1)1
B115 (59.0)95 (58.3)20 (62.5)0.00188.42
C39 (20.0)28 (17.2)11 (34.4)15.71
Mean MELD score ± SD14.2 ± 6.313.2 ± 5.219.1 ± 5.2< 0.0001
MELD score (Tertile)
6-11 (T1)77 (47.2)6 (18.8)1
12-15 (T2)46 (28.2)10 (31.3)0.00082.79
16-40 (T3)40 (24.5)16 (50.0)5.13
Surgery sites
Gastrointestinal101 (51.8)84 (51.5)17 (53.1)0.87
Cardiovascular and thoracic28 (14.4)22 (13.5)6 (18.8)0.42
Genitourinary24 (12.3)22 (13.5)2 (6.3)0.38
Orthopedic24 (12.3)20 (12.3)4 (12.5)-
Head and neck18 (9.2)15 (9.2)3 (9.4)-
Surgery type
Urgent57 (29.2)36 (22.1)21 (65.6)
Elective138 (70.8)127 (77.9)11 (34.4)< 0.0001
Table 2 Surgical procedures performed in 195 patients with cirrhosis
TotalElectiveUrgent
Procedures19513857
Gastrointestinal1016635
Hernia repair342113
Cholecystectomy23176
Exploratory/diagnostic1064
Biopsy of lesion990
Colectomy633
Abscess drainage312
Hemorrhoid ligation321
Pancreatectomy330
Small bowel resection303
Peptic ulcer oversewing202
Appendectomy101
Antrectomy (Billroth II)110
Gastric bypass110
Gastrostomy tube placement110
Splenectomy110
Cardiovascular and thoracic28253
Coronary artery bypass550
Video-assisted thoracoscopic surgery541
Abdominal aortic aneurysm repair440
Arteriovenous fistula/graft construction440
Cardiac valve replacement/repair330
Lung biopsy, open330
Pericardiectomy202
Heart transplant110
Pulmonary lobectomy110
Genitourinary24213
Cystoscopy/ureteroscopy15123
Dilation and curettage440
Hysterectomy330
Oophorectomy110
Transurethral resection of prostate110
Orthopedic241212
Total hip replacement660
Amputation532
Infected hip prosthesis removal404
Incision and drainage404
Open reduction - internal fixation321
Arthroscopy211
Head and neck18144
Endoscopic sinus surgery330
Laryngoscopy330
Parathyroidectomy330
Craniotomy211
Facial fracture reduction101
Mastoidectomy110
Neck dissection110
Parotidectomy110
Scleral buckle110
Teeth extraction101
Ventriculo-peritoneal shunt101
Table 3 Logistic regression analysis: odds ratio of death or decompensation in the postoperative period using the parameters of procedure urgency and the MELD score (A) or the CTP score (B)
Odds ratio95% CIP
A: MELD model
MELD (1 unit increase)1.1[1.03-1.17]0.0044
MELD (5 unit increase)1.58[1.16-2.19]
Elective (no vs yes)4.34[1.81-10.71]0.0011
B: CTP model
CTP (1 unit increase)1.25[1.00-1.57]0.0554
Elective (no vs yes)5.18[2.20-12.22]0.0002