The impact of cirrhosis and portal hypertension on mortality following colorectal surgery: A nationwide, population-based study

Geoffrey C. Nguyen, Adriano J. Correia, Paul J. Thuluvath

Research output: Contribution to journalArticle

Abstract

PURPOSE: Population-based data on outcomes associated with colorectal procedures in cirrhotic patients are sparse. We sought to assess the impact of liver cirrhosis and portal hypertension on mortality following colorectal surgery. METHODS: We queried patients who underwent colorectal surgery in the United States in the Nationwide Inpatient Sample (1998-2005). In-hospital mortality was determined for patients with no cirrhosis, compensated cirrhotic patients, and cirrhotic patients with portal hypertension. Multivariate logistic regression analysis was used to adjust for sociodemographic and clinical covariates. RESULTS: Patients with cirrhosis and cirrhosis with portal hypertension had significantly higher in-hospital mortality than patients with no cirrhosis (14% and 29% vs. 5%, respectively, P <0.0001). In-hospital mortality was also significantly higher for emergent and urgent colorectal procedures compared with elective procedures (9.2% vs. 1.8%, P <0.0001). Among elective colorectal procedures, adjusted mortality was increased in cirrhotic patients (adjusted odds ratio, 3.91; 95% confidence interval, 3.12-4.90) and cirrhotic patients with portal hypertension (adjusted odds ratio, 11.3; 95% confidence interval, 8.46-15.1) compared with patients with no cirrhosis. For nonelective procedures, the adjusted odds ratio for mortality in cirrhotic patients was 2.40 (95% confidence interval, 2.07-2.79) and in cirrhotic patients with portal hypertension the adjusted odds ratio was 5.88 (95% confidence interval, 4.90-7.06). Postoperative complications were more likely in cirrhotic patients (adjusted odds ratio, 1.35; 95% confidence interval, 1.20-1.52) and cirrhotic patients with portal hypertension (adjusted odds ratio, 1.82; 95% confidence interval, 1.55-2.15) relative to patients with no cirrhosis. CONCLUSIONS: Patients with liver cirrhosis, in particular, those with portal hypertension, have increased inhospital mortality and morbidity following colorectal surgery. Strategies are needed to optimize preoperative risk.

Original languageEnglish (US)
Pages (from-to)1367-1374
Number of pages8
JournalDiseases of the Colon and Rectum
Volume52
Issue number8
DOIs
StatePublished - Aug 2009

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Colorectal Surgery
Portal Hypertension
Fibrosis
Mortality
Population
Odds Ratio
Confidence Intervals
Hospital Mortality
Liver Cirrhosis

Keywords

  • Colorectal surgery
  • Liver cirrhosis
  • Mortality
  • Portal hypertension
  • Postoperative complication

ASJC Scopus subject areas

  • Gastroenterology

Cite this

The impact of cirrhosis and portal hypertension on mortality following colorectal surgery : A nationwide, population-based study. / Nguyen, Geoffrey C.; Correia, Adriano J.; Thuluvath, Paul J.

In: Diseases of the Colon and Rectum, Vol. 52, No. 8, 08.2009, p. 1367-1374.

Research output: Contribution to journalArticle

Nguyen, Geoffrey C. ; Correia, Adriano J. ; Thuluvath, Paul J. / The impact of cirrhosis and portal hypertension on mortality following colorectal surgery : A nationwide, population-based study. In: Diseases of the Colon and Rectum. 2009 ; Vol. 52, No. 8. pp. 1367-1374.
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abstract = "PURPOSE: Population-based data on outcomes associated with colorectal procedures in cirrhotic patients are sparse. We sought to assess the impact of liver cirrhosis and portal hypertension on mortality following colorectal surgery. METHODS: We queried patients who underwent colorectal surgery in the United States in the Nationwide Inpatient Sample (1998-2005). In-hospital mortality was determined for patients with no cirrhosis, compensated cirrhotic patients, and cirrhotic patients with portal hypertension. Multivariate logistic regression analysis was used to adjust for sociodemographic and clinical covariates. RESULTS: Patients with cirrhosis and cirrhosis with portal hypertension had significantly higher in-hospital mortality than patients with no cirrhosis (14{\%} and 29{\%} vs. 5{\%}, respectively, P <0.0001). In-hospital mortality was also significantly higher for emergent and urgent colorectal procedures compared with elective procedures (9.2{\%} vs. 1.8{\%}, P <0.0001). Among elective colorectal procedures, adjusted mortality was increased in cirrhotic patients (adjusted odds ratio, 3.91; 95{\%} confidence interval, 3.12-4.90) and cirrhotic patients with portal hypertension (adjusted odds ratio, 11.3; 95{\%} confidence interval, 8.46-15.1) compared with patients with no cirrhosis. For nonelective procedures, the adjusted odds ratio for mortality in cirrhotic patients was 2.40 (95{\%} confidence interval, 2.07-2.79) and in cirrhotic patients with portal hypertension the adjusted odds ratio was 5.88 (95{\%} confidence interval, 4.90-7.06). Postoperative complications were more likely in cirrhotic patients (adjusted odds ratio, 1.35; 95{\%} confidence interval, 1.20-1.52) and cirrhotic patients with portal hypertension (adjusted odds ratio, 1.82; 95{\%} confidence interval, 1.55-2.15) relative to patients with no cirrhosis. CONCLUSIONS: Patients with liver cirrhosis, in particular, those with portal hypertension, have increased inhospital mortality and morbidity following colorectal surgery. Strategies are needed to optimize preoperative risk.",
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AU - Correia, Adriano J.

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N2 - PURPOSE: Population-based data on outcomes associated with colorectal procedures in cirrhotic patients are sparse. We sought to assess the impact of liver cirrhosis and portal hypertension on mortality following colorectal surgery. METHODS: We queried patients who underwent colorectal surgery in the United States in the Nationwide Inpatient Sample (1998-2005). In-hospital mortality was determined for patients with no cirrhosis, compensated cirrhotic patients, and cirrhotic patients with portal hypertension. Multivariate logistic regression analysis was used to adjust for sociodemographic and clinical covariates. RESULTS: Patients with cirrhosis and cirrhosis with portal hypertension had significantly higher in-hospital mortality than patients with no cirrhosis (14% and 29% vs. 5%, respectively, P <0.0001). In-hospital mortality was also significantly higher for emergent and urgent colorectal procedures compared with elective procedures (9.2% vs. 1.8%, P <0.0001). Among elective colorectal procedures, adjusted mortality was increased in cirrhotic patients (adjusted odds ratio, 3.91; 95% confidence interval, 3.12-4.90) and cirrhotic patients with portal hypertension (adjusted odds ratio, 11.3; 95% confidence interval, 8.46-15.1) compared with patients with no cirrhosis. For nonelective procedures, the adjusted odds ratio for mortality in cirrhotic patients was 2.40 (95% confidence interval, 2.07-2.79) and in cirrhotic patients with portal hypertension the adjusted odds ratio was 5.88 (95% confidence interval, 4.90-7.06). Postoperative complications were more likely in cirrhotic patients (adjusted odds ratio, 1.35; 95% confidence interval, 1.20-1.52) and cirrhotic patients with portal hypertension (adjusted odds ratio, 1.82; 95% confidence interval, 1.55-2.15) relative to patients with no cirrhosis. CONCLUSIONS: Patients with liver cirrhosis, in particular, those with portal hypertension, have increased inhospital mortality and morbidity following colorectal surgery. Strategies are needed to optimize preoperative risk.

AB - PURPOSE: Population-based data on outcomes associated with colorectal procedures in cirrhotic patients are sparse. We sought to assess the impact of liver cirrhosis and portal hypertension on mortality following colorectal surgery. METHODS: We queried patients who underwent colorectal surgery in the United States in the Nationwide Inpatient Sample (1998-2005). In-hospital mortality was determined for patients with no cirrhosis, compensated cirrhotic patients, and cirrhotic patients with portal hypertension. Multivariate logistic regression analysis was used to adjust for sociodemographic and clinical covariates. RESULTS: Patients with cirrhosis and cirrhosis with portal hypertension had significantly higher in-hospital mortality than patients with no cirrhosis (14% and 29% vs. 5%, respectively, P <0.0001). In-hospital mortality was also significantly higher for emergent and urgent colorectal procedures compared with elective procedures (9.2% vs. 1.8%, P <0.0001). Among elective colorectal procedures, adjusted mortality was increased in cirrhotic patients (adjusted odds ratio, 3.91; 95% confidence interval, 3.12-4.90) and cirrhotic patients with portal hypertension (adjusted odds ratio, 11.3; 95% confidence interval, 8.46-15.1) compared with patients with no cirrhosis. For nonelective procedures, the adjusted odds ratio for mortality in cirrhotic patients was 2.40 (95% confidence interval, 2.07-2.79) and in cirrhotic patients with portal hypertension the adjusted odds ratio was 5.88 (95% confidence interval, 4.90-7.06). Postoperative complications were more likely in cirrhotic patients (adjusted odds ratio, 1.35; 95% confidence interval, 1.20-1.52) and cirrhotic patients with portal hypertension (adjusted odds ratio, 1.82; 95% confidence interval, 1.55-2.15) relative to patients with no cirrhosis. CONCLUSIONS: Patients with liver cirrhosis, in particular, those with portal hypertension, have increased inhospital mortality and morbidity following colorectal surgery. Strategies are needed to optimize preoperative risk.

KW - Colorectal surgery

KW - Liver cirrhosis

KW - Mortality

KW - Portal hypertension

KW - Postoperative complication

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