Outcomes after non-hepatic gastrointestinal surgery in patients with liver cirrhosis

Introduction: The mortality rates for various non-transplant surgical procedures in patients with cirrhosis generally range from 8.3% to 25%. In some reports, the mortality was as high as 70% in patients with poor liver function (high Child’s or model for end-stage liver disease (MELD) scores). Since data are limited, we analyzed our recent experience with cirrhotic patients undergoing emergent or elective non-hepatic gastrointestinal surgery at Sir Ganga Ram Hospital, New Delhi. METHODS: We retrospectively analysed, from a prospectively maintained database the records of all our patients with cirrhosis who underwent non-hepatic gastrointestinal surgery between June 2010 and May 2015. Our main objective was to study their outcome and predictors of mortality RESULTS: 54 non-hepatic gastrointestinal surgical procedures (44 intra-abdominal, 10 abdominal wall) were performed in these patients. Liver cirrhosis was classified according to the Child’s (7 Child’s A, 27 B, 20 C) and MELD scores (less than or greater than 15). Eighteen (33%) of the patients underwent emergency procedures. Most abdominal wall operations were for hernias (n=6). Intra-abdominal operations were on the small bowel (n=10), gall bladder (n=10), colon (n=7), pancreas (n=5), spleen (n=4), stomach (n=4), for GI bleeding (n=3) and others (diagnostic laparoscopy for abdominal TB, n=1). The patients’ mean age was 53 years (range 23-80 years) and the male: female ratio was 4:1. The most common cause for cirrhosis was alcoholic liver disease (n=30), followed by hepatitis B and hepatitis C (n=4 each) and not known in the rest. The overall perioperative mortality was 13% (3% in elective and 33% in emergent surgery; p 15; p<0.004). Category wise the mortality was as follows: pancreatic surgery (20%); surgery for obscure GI bleed (67%); gastric surgery, (25 %) small intestinal surgery (10%) and colonic surgery (28%). The mean hospital stay of the survivors was 10 days (range 1-37 days). CONCLUSIONS: We found that perioperative mortality was high in patients with liver cirrhosis undergoing non hepatic GI surgery, especially in emergent situations, those with a higher Child’s class, with greater MELD scores and who required more blood transfusions.