Improving survival in patients with cirrhosis undergoing major abdominal operations
K. R. Sirinek, R. R. Burk, M. Brown and B. A. Levine
Fifty-one patients with cirrhosis underwent 65 major abdominal procedures,
with an 8% mortality and a 28% complication rate. Preoperative and
perioperative management was comparable to that rendered patients with
cirrhosis undergoing portosystemic shunting procedures. Emergency
operation, persistent coagulation defects (prothrombin time and partial
thromboplastin time prolonged greater than 2 s), blood loss greater than 4
U, and exploration of the common bile duct were factors associated with
increased mortality. Major surgical procedures can be safely performed in
critically ill patients with cirrhosis with intensive preoperative care and
with minimizing intraoperative blood loss.
