The effect of preoperative liver dysfunction on cardiac surgery outcomes

Abstract

BackgroundTo determine the impact of preoperative Liver Dysfunction (LD) on outcomes after elective Coronary Artery Bypass Grafting (CABG) and Valvular surgery (VS).MethodsThe Nationwide Inpatient Sample (2002–2010) was queried to identify patients with LD who had elective CABG or VS utilizing ICD-9-CM diagnosis and procedure codes. These patients were matched with the similar patients without LD (controls) by propensity score matching. Chi-square and Wilcoxon rank sum tests were used for analysis.ResultsWe identified 1197 patients with LD (CABG = 755; VS = 442) who were matched to 2394 controls. LD significantly increased hospital mortality after both CABG (OR = 5.19; 95%CI = 2.93–9.20) and VS (OR = 7.49; 95%CI = 3.12–17.96). Overall rates of complications after CABG with LD were greater than in non-complicated cases (OR = 1.73; 95%CI = 1.46–2.05). Among them, there was an increase in bleeding (OR = 1.81;95%CI = 1.44–2.28), respiratory (OR = 2.33;95%CI = 1.86–2.93), renal (OR = 2.79;95%CI = 2.04–3.81), and infectious (OR = 2.93;95%CI = 2.14–4.01) complications. In general, the rates of complications after VS with LD were also greater than in non-complicated cases (OR = 2.77;95%CI = 2.13–3.60), specifically for bleeding (OR = 3.07;95%CI = 2.17–4.34), respiratory (OR = 3.57;95%CI = 2.51–5.07), renal (OR = 4.40;95%CI = 2.80–6.92), and infectious (OR = 4.63;95%CI = 2.85–7.51) complications. The development of LD significantly increased mean hospital length of stay (LOS) and total hospital charges after both CABG (from7.0 ± 4.0 to 9.2 ± 9.1 days and from $100,265 ± 87,107 to $117,756 ± 99,320, respectively; P < 0.0001 for both) and VS (from 7.9 ± 5.0 to 11.4 ± 9.9 days and from $134,306 ± 114,216 to $176,620 ± 147,049, respectively; P < 0.0001 for both).ConclusionsLD worsened the outcomes after cardiac surgery. It increased rates of complications, hospital mortality, length of stay and total hospital charges after both procedures.

The impact of cirrhosis in patients undergoing cardiac surgery: a retrospective observational cohort study

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Meta-analysis of short- and long-term outcomes after pure laparoscopic versus open liver surgery in hepatocellular carcinoma patients

“…Moreover, operations for hepatocellular carcinoma (HCC) in patients with liver cirrhosis and portal hypertension are considered difficult and may be associated with relatively high morbidity [ 12 ]. It has been proved that patients with liver cirrhosis have worse overall outcomes and a higher perioperative complication rate [ 13 , 14 ].…”

Model for End-Stage Liver Disease Score Independently Predicts Mortality in Cardiac Surgery

“…Another strategy is to simply stratify by presence of any liver disease, which has been shown in the national inpatient sample to dramatically increase rates of mortality and other complications. [23] In this analysis liver disease was a very strong independent predictor of operative mortality with an adjusted odds ratio of 2.08 (p<0.0001). Also consistent with prior results liver disease was independently associated with major morbidity (AOR 1.36, p=0.003).…”