Division of General and Minimally Invasive Surgery, Department of Surgery, Rutgers, New Jersey Medical School, Newark, NJ, USA.
Department of Surgery, East Orange Veterans Affairs Hospital, East Orange, NJ, USA.
J Invest Surg. 2021 Jun;34(6):617-626. doi: 10.1080/08941939.2019.1676846. Epub 2019 Oct 29.
Multiple studies have shown high rates of postoperative morbidity and mortality in individuals with chronic liver disease (CLD). However, analyses from comparisons with individuals without CLD are not available. Such analyses might provide opportunities to improve outcomes.
Data from The National Surgical Quality Improvement Program (NSQIP) from 2008 to 2011 were analyzed comparing CLD patients undergoing non-liver surgery propensity matched to those without CLD. Patients with CLD were stratified by Model of End Stage Liver Disease (MELD) scores <15 and ≥15. Primary outcome was all cause mortality, and secondary outcomes were composite and individual morbidity, hospital length of stay, readmission, reoperation, and discharge destination. Odds ratios (OR) were calculated, and length of hospital stay was estimated using Poisson regression.
There were 6,209 patients with CLD (4,013 with low MELD, 2,196 with high MELD) matched to 18,627 patients without. Patients with CLD had 1.8- and 3.3-times higher odds of mortality (95% CI 1.6-2.1 for Low MELD (10.6%), 2.9-3.8 for high MELD (35.2%), and 1.8- and 2.2-times higher odds of any morbidity (1.6-1.9 and 1.9-2.4). Complications specific to CLD were increased based on MELD specifically coma (OR 1.6, 0.9-2.9 for Low MELD, 2.2, 1.5-3.2 for High MELD), renal failure (OR 1.4, 1.1-1.8 and 2.4, 2.0-2.9), and bleeding (OR 1.7, 1.5-1.9 and 2.0, 1.8-2.3). They also had a 20% and 80% longer length of stay, 2.2- and 3.4-times higher odds of being discharged somewhere other than home, 1.7- and 1.6-times higher odds of readmission, and 1.5- and 1.6-times higher odds of reoperation.
Patients with CLD have significantly higher odds of mortality and morbidity, which is increased with a higher MELD. Interventions that decrease those morbidities are needed and have the potential to decrease mortality and resource utilization.
多项研究表明，患有慢性肝病（CLD）的个体术后发病率和死亡率较高。然而，尚无与无 CLD 个体进行比较的分析。这样的分析可能提供改善结果的机会。
对 2008 年至 2011 年全国外科质量改进计划（NSQIP）的数据进行了分析，比较了接受非肝脏手术的 CLD 患者与无 CLD 患者。根据终末期肝病模型（MELD）评分<15 和≥15 对 CLD 患者进行分层。主要结局为全因死亡率，次要结局为复合和单一发病率、住院时间、再入院、再次手术和出院去向。计算比值比（OR），并使用泊松回归估计住院时间。
共有 6209 例 CLD 患者（低 MELD 组 4013 例，高 MELD 组 2196 例）与 18627 例无 CLD 患者相匹配。CLD 患者的死亡率高出 1.8 至 3.3 倍（低 MELD（10.6%）为 1.6-2.1，高 MELD（35.2%）为 2.9-3.8），发病率高出 1.8 至 2.2 倍（1.6-1.9 和 1.9-2.4）。根据 MELD，特定于 CLD 的并发症也有所增加，具体表现为昏迷（低 MELD 组 OR 1.6，0.9-2.9，高 MELD 组 OR 2.2，1.5-3.2）、肾衰竭（OR 1.4，1.1-1.8 和 2.4，2.0-2.9）和出血（OR 1.7，1.5-1.9 和 2.0，1.8-2.3）。他们的住院时间也延长了 20%和 80%，出院去向为非家庭的几率高出 2.2-3.4 倍，再入院的几率高出 1.7-1.6 倍，再次手术的几率高出 1.5-1.6 倍。
患有 CLD 的患者死亡率和发病率明显较高，而 MELD 评分较高则会增加这一风险。需要采取降低这些发病率的干预措施，这有可能降低死亡率和资源利用。
