Surgical Outcomes of Patients with Cirrhotic or Non-cirrhotic Liver Disease in an Acute Care Setting: An Analysis of the Nationwide Inpatient Sample

Punam V Patel, MD, Sri Ram Pentakota, MD, MPH, PHD, Aziz Merchant, MD. Rutgers – NJMS

Introduction: Morbidity and mortality in patients with liver disease undergoing surgical intervention is known to be greater than the average patient, however the type of disease is rarely differentiated. We analyzed data from the Nationwide Inpatient Sample to determine the association of type of liver disease and type of surgery on surgical outcomes.

Methods: The Nationwide Inpatient Sample from 2006-2010 was used to identify patients undergoing specified general surgical interventions in an acute care setting. These patients were categorized as cirrhotic, non-cirrhotic and those with no liver disease.  Study outcomes were in-hospital mortality, any surgical complication and any medical complications. Descriptive statistics were calculated using proportions (for categorical variables) and mean and standard deviation (SD) (for continuous variables). Unadjusted and adjusted logistic regression models were fit to assess the association between type of liver disease and the study outcomes. Covariates included were age, race, gender, payer type, number of comorbid conditions, lap versus open surgery.

Results: Of the 893861 patients identified, 11343 (1.27%), 15138 (1.69%), and 867200 (97.04%) had diagnoses of cirrhotic liver disease, non-cirrhotic liver disease and no liver disease, respectively. The mean age of the overall cohort was 52.97 years (SD 19.97).  The cohort was 55% white; mostly female (58.51%) and had private (41%) or government (44%) insurance. Overall, 70% of patients had at least one chronic comorbid condition. Laparoscopic surgery was performed in 49.78% of patients. Complication rates in the overall cohort were 3%, 8.1%, and 22.8% for in-hospital mortality,  surgical, and medical complications, respectively.

 Type of liver disease Overall Mortality# Surgical complications# Medical complications#
cirrhotic vs none 2.89 (2.70-3.10) 1.35 (1.28-1.43) 1.49 (1.43-1.55)
non-cirrhotic vs none 1.45 (1.31-1.61) 1.09 (1.02-1.16) 1.03 (0.99-1.08)
cirrhotic vs non-cirrhotic 1.99 (1.76-2.25) 1.24 (1.14-1.35) 1.45 (1.37-1.54)
laparoscopic vs open 0.11 (0.11-0.12) 0.17 (0.16-0.17) 0.57 (0.56-0.58)

#Adjusted Odds Ratios from multivariable logistic regression models; Variables: type of liver disease, age, gender, race, payer type, number of chronic comorbidities, and lap/open surgery.

Conclusions: Based on our cohort, patients with cirrhotic disease are at increased risk for poor outcomes when compared to those with non-cirrhotic disease. Patients undergoing laparoscopic surgery have significantly favorable outcomes compared to those undergoing open surgery.  

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