Prognostic Risk Factors for Surgery in Patients with Cirrhotic Portal

Background: In the clinical management of cirrhotic portal hypertension, surgery is often necessary; however, the operative mortality rate is high. Methods: Data from 161 patients who underwent surgery for cirrhotic portal hypertension were analyzed, and 24 potential predictors of surgical outcome were assessed. A Kruskal Wallis rank sum test was used for single-factor comparisons, and multivariate logistic regression for multi-factor comparisons to identify risk factors for poor surgical outcomes and calculate their scores. Results: Six predictors of poor surgical outcomes were identified: postoperative bleeding within 30h of >2L, with a score of 3; severe liver atrophy (an anteroposterior diameter of the left lobe of ≤55 mm and an oblique diameter of the right lobe ≤ 110mm), with a score of 3; a base excess of 2 L, with a score of 2; and a red blood cell count of <3G/L, with a score of 1. For patients with a good outcome (n=147), all patients had a score of ≤ 3, except one patient who had a score of 4. With respect to patients that died (n=14), all had a score of ≥ 5, except one patient who had a score of 4. A significant difference was observed between the two groups (P<0.05). The mortality was 100% in patients with a score of ≥ 7. Conclusions: Six risk factors for poor surgical outcomes were identified in this study. Operative mortality appears to be significantly increased in patients with a score of 5-6. Surgery should be contraindicated in patients with a score of ≥ 7. To reduce mortality, close attention should be paid to preoperative and intraoperative treatment and prevention to achieve a score of <4.