Abstract
Background: In the clinical management of cirrhotic portal hypertension, surgery is often necessary; however, the operative mortality rate is high. Methods: Data from 161 patients who underwent surgery for cirrhotic portal hypertension were analyzed, and 24 potential predictors of surgical outcome were assessed. A Kruskal Wallis rank sum test was used for single-factor comparisons, and multivariate logistic regression for multi-factor comparisons to identify risk factors for poor surgical outcomes and calculate their scores. Results: Six predictors of poor surgical outcomes were identified: postoperative bleeding within 30h of >2L, with a score of 3; severe liver atrophy (an anteroposterior diameter of the left lobe of ≤55 mm and an oblique diameter of the right lobe ≤ 110mm), with a score of 3; a base excess of 2 L, with a score of 2; and a red blood cell count of <3G/L, with a score of 1. For patients with a good outcome (n=147), all patients had a score of ≤ 3, except one patient who had a score of 4. With respect to patients that died (n=14), all had a score of ≥ 5, except one patient who had a score of 4. A significant difference was observed between the two groups (P<0.05). The mortality was 100% in patients with a score of ≥ 7. Conclusions: Six risk factors for poor surgical outcomes were identified in this study. Operative mortality appears to be significantly increased in patients with a score of 5-6. Surgery should be contraindicated in patients with a score of ≥ 7. To reduce mortality, close attention should be paid to preoperative and intraoperative treatment and prevention to achieve a score of <4.
Highlights
Caused by viral hepatitis-induced cirrhotic portal hypertension is very common in clinical practice
In patients with cirrhotic portal hypertension, 35% of cases have ≤ 50,000 platelets in blood circulation, 40% of cases have a history of upper gastrointestinal hemorrhage, [2] and 18-23% of cases are complicated by liver cancer [3,4]
Sixteen factors, including liver volume, Child-Pugh classification, Prothrombin Time (PT), serum albumin, degree of esophageal varices, spleen size, Platelet (PLT) count, White Blood Cell (WBC) count, Red Blood Cell (RBC) count, Hemoglobin (Hb), blood pH, Base Excess (BE), ascites volume, operative time, and intraoperative and postoperative wound bleeding volume within 30 h had a significant correlation with prognosis (P
Summary
Caused by viral hepatitis-induced cirrhotic portal hypertension is very common in clinical practice. In patients with cirrhotic portal hypertension, 35% of cases have ≤ 50,000 platelets in blood circulation, 40% of cases have a history of upper gastrointestinal hemorrhage, [2] and 18-23% of cases are complicated by liver cancer [3,4]. The majority of these patients requires surgery, with a goal of staunching bleeding, eliminating splenomegaly and severe hypersplenism (hereinafter referred to as hypersplenism), and resecting liver tumors; the surgical risks are great and the mortality rates are high. In the clinical management of cirrhotic portal hypertension, surgery is often necessary; the operative mortality rate is high
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