Factors Influencing the Mortality in Patients with Hepatic Cirrhosis Undergoing Major Abdominal Oberations

ABSTRACT

Recent reports have shown that the mortality is high in cirrhotic patients undergoing major abdominal operations. However, little information is available on the mechanism of the these high operative risks. The aims of this study were to determine the factors that may influence the mortality following major abdominal operations. We reviewed sixty-two patients with cirrhosis who had undergone major abdominal operations at Korea Veterans Hospital during the period from January 1984 to June 1995. There were 49 men and 13 women, with a mean age of 58.0 years (range=37 to 77 years). The postoperative mortality rate was 19.4%. Various clinical and laboratory factors were examined to find their relationships to the postoperative outcome. By univariate analysis, significant prognostic factors affecting the mortality rate were as follows a serum albumin level less than 3 g/dl, a prothrombin time (PT) and a partial thromboplastin time (PTT) prolongation of more than 2 second over that of the controls, a platelet count of less than 80,000/mm3, an emergency operation, Hb at arrival of less than 10 g/dl, ascites, an intraoperative blood loss greater than 1000 ml, and an operative time longer than 2 hours(P<0.05). However, only two factors, a serum albumin level less than 3 g/dl and a platelet count less than 80,000/mm3 were significant by dpmultivariate analysis. In conclusion, when operative treatment is undertaken in patients with cirrhosis, preoperative correction of coagulopathy and ascites, the simplest and most expeditious operative procedure, and meticulous hemostasis and perioperative hemodynamic monitoring are essential to reduce the postoperative mortality.