Adverse outcomes in patients with chronic liver disease undergoing colorectal surgery

Amir A. Ghaferi, Amit Mathur, Christopher J. Sonnenday, Justin B. Dimick

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Objective: We sought to use a multi-institutional, prospective, clinical database to better understand adverse outcomes in chronic liver disease (CLD) patients undergoing colorectal surgery. Background: CLD confers significant perioperative risk. However, there are little population-based data available for prognostication and risk stratification in these patients. Methods: We used data from the 2005-2007 American College of Surgeons National Surgical Quality Improvement Project to study 30,927 patients undergoing colorectal resections. We first identified patients with CLD (n = 1565) with any of the following clinical characteristics: ascites, esophageal varices, or total bilirubin greater than 2 mg/dL. Postoperative complications and mortality rates were then compared between CLD and non-CLD patients. Results: CLD patients have a nearly 6.5-fold increased risk of mortality following colorectal operations (Relative Risk [RR], 6.53; 3.2% in non-CLD group versus 21.5% in CLD group). Patients with CLD also had significantly higher major complication rates (RR, 2.72; 15.4% vs. 41.9%, respectively). The failure to rescue rate (ie, proportion of deaths following major complications) was also markedly higher in patients with CLD (RR, 2.27; 15.1% vs. 34.2%, respectively). Furthermore, stratification of CLD patients by Model for End-stage Liver Disease (MELD) score demonstrated significantly higher rates of complications (RR, 2.41; 2.31-2.51), failure to rescue (RR, 2.62; 2.35-2.90), and mortality (RR, 8.92; 8.11-9.78) in CLD patients with MELD <15 compared with CLD patients with MELD <15. Conclusions: Colorectal surgery in CLD patients is associated with significant morbidity and mortality. Furthermore, those who develop major complications have a significantly higher risk of death compared to non-CLD. These very high risks should be discussed at length with patients prior to undertaking major surgical procedures.

Original languageEnglish (US)
Pages (from-to)345-350
Number of pages6
JournalAnnals of Surgery
Volume252
Issue number2
DOIs
StatePublished - Aug 2010
Externally publishedYes

Fingerprint

Colorectal Surgery
Liver Diseases
Chronic Disease
End Stage Liver Disease
Mortality
Esophageal and Gastric Varices
Quality Improvement
Bilirubin
Ascites

ASJC Scopus subject areas

  • Surgery

Cite this

Adverse outcomes in patients with chronic liver disease undergoing colorectal surgery. / Ghaferi, Amir A.; Mathur, Amit; Sonnenday, Christopher J.; Dimick, Justin B.

In: Annals of Surgery, Vol. 252, No. 2, 08.2010, p. 345-350.

Research output: Contribution to journalArticle

Ghaferi, Amir A. ; Mathur, Amit ; Sonnenday, Christopher J. ; Dimick, Justin B. / Adverse outcomes in patients with chronic liver disease undergoing colorectal surgery. In: Annals of Surgery. 2010 ; Vol. 252, No. 2. pp. 345-350.
@article{649ccca4a74c4f029f9faa59100dca97,
title = "Adverse outcomes in patients with chronic liver disease undergoing colorectal surgery",
abstract = "Objective: We sought to use a multi-institutional, prospective, clinical database to better understand adverse outcomes in chronic liver disease (CLD) patients undergoing colorectal surgery. Background: CLD confers significant perioperative risk. However, there are little population-based data available for prognostication and risk stratification in these patients. Methods: We used data from the 2005-2007 American College of Surgeons National Surgical Quality Improvement Project to study 30,927 patients undergoing colorectal resections. We first identified patients with CLD (n = 1565) with any of the following clinical characteristics: ascites, esophageal varices, or total bilirubin greater than 2 mg/dL. Postoperative complications and mortality rates were then compared between CLD and non-CLD patients. Results: CLD patients have a nearly 6.5-fold increased risk of mortality following colorectal operations (Relative Risk [RR], 6.53; 3.2{\%} in non-CLD group versus 21.5{\%} in CLD group). Patients with CLD also had significantly higher major complication rates (RR, 2.72; 15.4{\%} vs. 41.9{\%}, respectively). The failure to rescue rate (ie, proportion of deaths following major complications) was also markedly higher in patients with CLD (RR, 2.27; 15.1{\%} vs. 34.2{\%}, respectively). Furthermore, stratification of CLD patients by Model for End-stage Liver Disease (MELD) score demonstrated significantly higher rates of complications (RR, 2.41; 2.31-2.51), failure to rescue (RR, 2.62; 2.35-2.90), and mortality (RR, 8.92; 8.11-9.78) in CLD patients with MELD <15 compared with CLD patients with MELD <15. Conclusions: Colorectal surgery in CLD patients is associated with significant morbidity and mortality. Furthermore, those who develop major complications have a significantly higher risk of death compared to non-CLD. These very high risks should be discussed at length with patients prior to undertaking major surgical procedures.",
author = "Ghaferi, {Amir A.} and Amit Mathur and Sonnenday, {Christopher J.} and Dimick, {Justin B.}",
year = "2010",
month = "8",
doi = "10.1097/SLA.0b013e3181e982d6",
language = "English (US)",
volume = "252",
pages = "345--350",
journal = "Annals of Surgery",
issn = "0003-4932",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - Adverse outcomes in patients with chronic liver disease undergoing colorectal surgery

AU - Ghaferi, Amir A.

AU - Mathur, Amit

AU - Sonnenday, Christopher J.

AU - Dimick, Justin B.

PY - 2010/8

Y1 - 2010/8

N2 - Objective: We sought to use a multi-institutional, prospective, clinical database to better understand adverse outcomes in chronic liver disease (CLD) patients undergoing colorectal surgery. Background: CLD confers significant perioperative risk. However, there are little population-based data available for prognostication and risk stratification in these patients. Methods: We used data from the 2005-2007 American College of Surgeons National Surgical Quality Improvement Project to study 30,927 patients undergoing colorectal resections. We first identified patients with CLD (n = 1565) with any of the following clinical characteristics: ascites, esophageal varices, or total bilirubin greater than 2 mg/dL. Postoperative complications and mortality rates were then compared between CLD and non-CLD patients. Results: CLD patients have a nearly 6.5-fold increased risk of mortality following colorectal operations (Relative Risk [RR], 6.53; 3.2% in non-CLD group versus 21.5% in CLD group). Patients with CLD also had significantly higher major complication rates (RR, 2.72; 15.4% vs. 41.9%, respectively). The failure to rescue rate (ie, proportion of deaths following major complications) was also markedly higher in patients with CLD (RR, 2.27; 15.1% vs. 34.2%, respectively). Furthermore, stratification of CLD patients by Model for End-stage Liver Disease (MELD) score demonstrated significantly higher rates of complications (RR, 2.41; 2.31-2.51), failure to rescue (RR, 2.62; 2.35-2.90), and mortality (RR, 8.92; 8.11-9.78) in CLD patients with MELD <15 compared with CLD patients with MELD <15. Conclusions: Colorectal surgery in CLD patients is associated with significant morbidity and mortality. Furthermore, those who develop major complications have a significantly higher risk of death compared to non-CLD. These very high risks should be discussed at length with patients prior to undertaking major surgical procedures.

AB - Objective: We sought to use a multi-institutional, prospective, clinical database to better understand adverse outcomes in chronic liver disease (CLD) patients undergoing colorectal surgery. Background: CLD confers significant perioperative risk. However, there are little population-based data available for prognostication and risk stratification in these patients. Methods: We used data from the 2005-2007 American College of Surgeons National Surgical Quality Improvement Project to study 30,927 patients undergoing colorectal resections. We first identified patients with CLD (n = 1565) with any of the following clinical characteristics: ascites, esophageal varices, or total bilirubin greater than 2 mg/dL. Postoperative complications and mortality rates were then compared between CLD and non-CLD patients. Results: CLD patients have a nearly 6.5-fold increased risk of mortality following colorectal operations (Relative Risk [RR], 6.53; 3.2% in non-CLD group versus 21.5% in CLD group). Patients with CLD also had significantly higher major complication rates (RR, 2.72; 15.4% vs. 41.9%, respectively). The failure to rescue rate (ie, proportion of deaths following major complications) was also markedly higher in patients with CLD (RR, 2.27; 15.1% vs. 34.2%, respectively). Furthermore, stratification of CLD patients by Model for End-stage Liver Disease (MELD) score demonstrated significantly higher rates of complications (RR, 2.41; 2.31-2.51), failure to rescue (RR, 2.62; 2.35-2.90), and mortality (RR, 8.92; 8.11-9.78) in CLD patients with MELD <15 compared with CLD patients with MELD <15. Conclusions: Colorectal surgery in CLD patients is associated with significant morbidity and mortality. Furthermore, those who develop major complications have a significantly higher risk of death compared to non-CLD. These very high risks should be discussed at length with patients prior to undertaking major surgical procedures.

UR - http://www.scopus.com/inward/record.url?scp=77955172758&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77955172758&partnerID=8YFLogxK

U2 - 10.1097/SLA.0b013e3181e982d6

DO - 10.1097/SLA.0b013e3181e982d6

M3 - Article

C2 - 20622652

AN - SCOPUS:77955172758

VL - 252

SP - 345

EP - 350

JO - Annals of Surgery

JF - Annals of Surgery

SN - 0003-4932

IS - 2

ER -