Key factors of therapeutic effects for surgery in patients with cirrhotic portal hypertension

Y.-F. Lv, X.-Y. Han, X.-G. Gong, N. Liu, J. Yue, Y.-J. Li, S.-J. Zhang, Y.-B. Pang

Department of General Surgery, Hainan Provincial People’s Hospital, Haikou, China. liyejuan2009@163.com

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• Gastroenterology

OBJECTIVE: In the clinical management of cirrhotic portal hypertension, surgery is often necessary; however, the operative mortality rate is high.

PATIENTS AND 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 multifactor comparisons to identify key factors for poor surgical outcomes and calculate their scores.

RESULTS: Six predictors of poor surgical outcomes were identified: postoperative bleeding within 30 h of > 2 L, 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 ≤ 110 mm), with a score of 3; a base excess of <−3 mmol/L, with a score of 3; a platelet count of <3 T/L, with a score of 2; an amount of intraoperative bleeding of > 2 L, with a score of 2; and a red blood cell count of < 3 G/L, with a score of 1. For patients with good outcome (n = 147), all patients had a score of ≤ 3, except one patient who had a score of 4. With respect to patients who 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 key 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.

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