MORBIDITY OF SURGERY IN PREVIOUSLY UNDIAGNOSED CIRRHOTIC PATIENTS
AbstractBackground: Undiagnosed cirrhotic patients are frequently encountered during routine and emergency surgery. These patients have a higher incidence of blood loss & wound infection, resulting in prolonged hospital stay. This study was conducted to highlight the possible complications which result in prolonged hospital stay in these patients. Methods: A total of 38 patients were incidentally found to have cirrhosis out of a total of 1560 patients who underwent abdominal operation. Diagnosis was confirmed on per-operative liver biopsy and was suspected preoperatively in patient having abnormal liver function test. Per-operative bleeding, postoperative wound infection and hospital stay was compared in cirrhotic and non-cirrhotic patients. Results: The mean blood loss was 310 ml in cirrhotic patients as compared to 205 ml in non-cirrhotic patients which was statistically significant (p-value 0.008). Post-operative infection rate was 21% in cirrhotic patients compared to non- cirrhotic patients 5%. Significance was tested using Pearson Chi square test (0.042). The Average hospital stay was 10 days in cirrhotic patients and 7.5 days in non-cirrhotic patients respectively which was statistically significant (p-value 0.006). Conclusion: There is statistically significant difference in per-operative bleeding, wound infection and hospital stay in cirrhotic and non-cirrhotic patients.
Csikez NG, Nquyen LN, Teng JF, Shah SA. Nationwide volume and mortality after elective surgery in cirrhotic patients. J Am coll Surg 2009;208(1) 96–103.
Mahmood S. Ascites. The profile of patients and its causes. Specialist vol No 3 1990;96–97.
Younossi ZM , Sephenova M, Afendy M, Fang Y, Younossi Y, Mir H, et al. Changes in prevalence of most common causes of chronic liver disease in Unites States from 1988 to 2008. Clin Gastroenterol Hepatol 2011;9(6)524–30.
Neef H ,Manaskin D, Spangenburg HC, Hopt UT, Makowiec F. Peroperatve mortality after non hepatic general surgery in patients with liver cirrhosis: An analysis of 138 operation in the 2000s using Child and MELD score . J Gastrointest Surg 2011;15(1):1–11.
Boucher IA. Postmortem study of frequency of gallstones in patients with cirrhosis of the liver. Gut 1969;10(9):705–10.
Hickman MS, Schwesinger WH, Page CP. Acute cholecystitis in diabetics. A case-control study of outcome. Arch Surg 1988;123(4):409–11.
Geode BD, Klitsie PJ, Lange JF. Morbidity and mortality related to non-hepatic surgery in patients with cirrhosis; a systemic review. Best Pract Res Clin Gastroenterol 2012;26(1):47–59.
Aranha GV, Sontag SJ, Greenlee HB. Cholecystectomy in cirrhotic patients :a formidable operation. Am J Surg1982;143(1):55–60.
Nicoll A. Surgical risk in patients with cirrhosis. J Gastroenterol Hepatol. 2012;27(10):1569–71.
McGillicuddy JW, Villar JJ, Rohan VS, Bazaz S, Taber DJ, Pilch NA, et al. Is cirrhosis a contraindication to laproscopic cholecystectomy. Am Surg 2015;81(1):52–5.
Schwartz SI. Biliary tract surgery and cirrhosis: a critical combination. Surgery 1981;90(4):577–83.
Hamid S, Siddique M, Jaffri W, Shah H, Khan H, Ahmed M. Outcome of biliary tract surgery in cirrhitics;a case control study. Ann R Coll Surg Engl 1993;75(6):434–6.