Abstract
BackgroundPatients with cirrhosis undergoing colectomy have a higher risk of postoperative mortality, but contemporary estimates are lacking and data on associated risk and longer term outcomes are limited. This study aimed to quantify the risk of mortality following colectomy by urgency of surgery and stage of cirrhosis.Data sources.Linked primary and secondary-care electronic healthcare data from England were used to identify all patients undergoing colectomy from January 2001 to December 2017. These patients were classified by the absence or presence of cirrhosis and severity. Case fatality rates at 90 days and 1 year were calculated, and cox regression was used to estimate the hazard ratio of postoperative mortality controlling for age, gender and co-morbidity.ResultsOf the total, 36,380 patients undergoing colectomy, 248 (0.7%) had liver cirrhosis, and 70% of those had compensated cirrhosis. Following elective colectomy, 90-day case fatality was 4% in those without cirrhosis, 7% in compensated cirrhosis and 10% in decompensated cirrhosis. Following emergency colectomy, 90-day case fatality was higher; it was 16% in those without cirrhosis, 35% in compensated cirrhosis and 41% in decompensated cirrhosis. This corresponded to an adjusted 2.57 fold (95% CI 1.75–3.76) and 3.43 fold (95% CI 2.02–5.83) increased mortality risk in those with compensated and decompensated cirrhosis, respectively. This higher case fatality in patients with cirrhosis persisted at 1 year.ConclusionPatients with cirrhosis undergoing emergency colectomy have a higher mortality risk than those undergoing elective colectomy both at 90 days and 1 year. The greatest mortality risk at 90 days was in those with decompensation undergoing emergency surgery.
Highlights
The overall incidence of chronic liver disease and cirrhosis is rising in most European and Western populations [1] secondary to alcohol misuse and the obesity pandemic [2]
A recent systematic review that focused on alcoholic liver disease was able to identify only two studies reporting on mortality risk following colectomy in this patient group, emphasizing the scarcity of work in this area [8]
There was a male preponderance amongst the patients with cirrhosis undergoing colectomy
Summary
The overall incidence of chronic liver disease and cirrhosis is rising in most European and Western populations [1] secondary to alcohol misuse and the obesity pandemic [2]. Most contemporary studies directly investigating postoperative outcomes in patients with cirrhosis have been limited to single-centre retrospective observational studies with an inherently higher risk of bias [8, 13, 14] These studies [13,14,15,16,17] have explored only short-term outcomes limited to the in-hospital period or 30 days following surgery and have not focused on the difference between elective and emergency cases [15,16,17]. This corresponded to an adjusted 2.57 fold (95% CI 1.75–3.76) and 3.43 fold (95% CI 2.02–5.83) increased mortality risk in those with compensated and decompensated cirrhosis, respectively This higher case fatality in patients with cirrhosis persisted at 1 year. The greatest mortality risk at 90 days was in those with decompensation undergoing emergency surgery
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