Morbidity and mortality in cirrhotic patients undergoing anesthesia and surgery

Avishai Ziser, David J. Plevak, Russell H. Wiesner, Jorge Rakela, Kenneth P. Offord, David L. Brown

Research output: Contribution to journalArticle

253 Citations (Scopus)

Abstract

Background: Patients with cirrhosis have a reduced life expectancy. Anesthesia and surgery have been associated with clinical decompensation in patients with cirrhosis. Methods: The authors retrospectively reviewed the records of all patients with the diagnosis of cirrhosis who underwent any surgical procedure under anesthesia at their institution between January 1980 and January 1991 (n = 733). Univariate and multivariate analyses were used to identify the variables associated with perioperative complications and short- and long-term survival. Results: The perioperative mortality rate (within 30 days of surgery) was 11.6%. The perioperative complication rate was 30.1%. Postoperative pneumonia was the most frequent complication. Multivariate factors that were associated with perioperative complications and mortality included male gender, a high Child-Pugh score, the presence of ascites, a diagnosis of cirrhosis other than primary biliary cirrhosis (especially cryptogenic cirrhosis), an elevated creatinine concentration, the diagnosis of chronic obstructive pulmonary disease, preoperative infection, preoperative upper gastrointestinal bleeding, a high American Society of Anesthesiologists physical status rating, a high surgical severity score, surgery on the respiratory system, and the presence of intraoperative hypotension. Conclusion: Risk factors have been identified for patients with cirrhosis who undergo anesthesia and surgery.

Original languageEnglish (US)
Pages (from-to)42-53
Number of pages12
JournalAnesthesiology
Volume90
Issue number1
StatePublished - Jan 1999

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Fibrosis
Anesthesia
Morbidity
Mortality
Biliary Liver Cirrhosis
Life Expectancy
Ambulatory Surgical Procedures
Ascites
Respiratory System
Hypotension
Chronic Obstructive Pulmonary Disease
Creatinine
Pneumonia
Multivariate Analysis
Hemorrhage
Survival
Infection

Keywords

  • Liver disease
  • Perioperative complications
  • Risk factors

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Ziser, A., Plevak, D. J., Wiesner, R. H., Rakela, J., Offord, K. P., & Brown, D. L. (1999). Morbidity and mortality in cirrhotic patients undergoing anesthesia and surgery. Anesthesiology, 90(1), 42-53.

Morbidity and mortality in cirrhotic patients undergoing anesthesia and surgery. / Ziser, Avishai; Plevak, David J.; Wiesner, Russell H.; Rakela, Jorge; Offord, Kenneth P.; Brown, David L.

In: Anesthesiology, Vol. 90, No. 1, 01.1999, p. 42-53.

Research output: Contribution to journalArticle

Ziser, A, Plevak, DJ, Wiesner, RH, Rakela, J, Offord, KP & Brown, DL 1999, 'Morbidity and mortality in cirrhotic patients undergoing anesthesia and surgery', Anesthesiology, vol. 90, no. 1, pp. 42-53.
Ziser A, Plevak DJ, Wiesner RH, Rakela J, Offord KP, Brown DL. Morbidity and mortality in cirrhotic patients undergoing anesthesia and surgery. Anesthesiology. 1999 Jan;90(1):42-53.
Ziser, Avishai ; Plevak, David J. ; Wiesner, Russell H. ; Rakela, Jorge ; Offord, Kenneth P. ; Brown, David L. / Morbidity and mortality in cirrhotic patients undergoing anesthesia and surgery. In: Anesthesiology. 1999 ; Vol. 90, No. 1. pp. 42-53.
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