Perioperative Blood Loss Is a Major Risk Factor for Nonshunt Celiotomies in Patients with Liver Cirrhosis - Clinical and Experimental Evidence

Abstract

The records of 76 consecutive cirrhotic patients undergoing nonshunt celiotomy were reviewed. Hospital mortality was 14.5%, and emergent operations were more frequent in nonsurvivors than survivors (p < 0.001). Nonsurvivors also had a higher incidence of reoperation and greater perioperative blood loss: 783 and 1,722 ml in survivors and nonsurvivors, respectively (p < 0.001). Major postoperative complications, such as intra-abdominal hemorrhage, gastrointestinal bleeding and/or severe infection occurred in all nonsurvivors and were significantly less frequent in survivors (p < 0.001). Hypotension for 1 h was induced by exsanguination in thioacetamide-induced liver cirrhosis in rats. After subsequent blood transfusion, both liver and kidney tissue blood flow, tissue ATP concentration and energy charge remained depressed in cirrhotic rats, despite normalized arterial pressure (p < 0.01). Perioperative hemorrhage is a major risk factor for subsequent hepatic and renal failure.