Perioperative risk factors in patients with liver disease undergoing non-hepatic surgery

Table 1 Child-turcotte-pugh scoring system

Variables	Points
	1	2	3
Encephalopathy grade	None	1 and 2	3 and 4
Ascites	Absent	Controlled	Refractory
Bilirubin (mg/dL)	1.5	1.5-2.0	> 2.0
Albumin (gm/dL)	3.5	2.0-3.5	< 2.0
Prothrombin time	1-4	4-6	> 6

Table 2 Preoperative variables and mortality rates of survivors and non-survivors of abdominal surgery

Preoperative variables	Percent of mortality if factors present	Percent of mortality if factors absent
Child class
A	10
B	31
C	76
Ascites	58	11
Emergency surgery	57	10
Bilirubin > 3 mg/dL	62	17
Albumin < 3 mg/dL	58	12
Prothrombin time > 1.5 s above control	63	18
White blood cell count > 10 000	54	19
P < 0.01 for all variables

Table 3 Preoperative variable associated with mortality

Preoperative variable	Mortality in percent if present
Pulmonary failure	100
Cardiac failure	92
Requirement of > 2 antibiotics	82
Renal failure	73
Hepatic failure	66
Gastrointestinal bleeding	86
Required second operation	81
Positive cultures	61
Blood requirement > 2 units	69
Blood requirement < 2 units	22

Table 4 Factors predictive of perioperative complications and of postoperative mortality

Predictor of complications	Predictor of mortality
Child-pugh class B and C	Male gender
Ascites	Child-Pugh class B and C
Etiology of cirrhosis other than primary biliary cirrhosis	Etiology of cirrhosis other than primary biliary cirrhosis
Elevated creatinine	Ascites
Preoperative infection	Preoperative infection
Chronic obstructive pulmonary disease	Respiratory surgery
Preoperative upper gastrointestinal bleed	American Society of Anaesthesiologists physical status IV and V
Invasiveness of surgical procedure
Intraoperative hypotension (20% decrease of base line blood pressure for 10 min or more)
American Society of Anaesthesiologists physical status IV and V

Table 5 Mortality rates in patients undergone cholecystectomy with or without cirrhosis

Variables	Mortality
Patients with normal liver function	1%
Patients with cirrhosis (PT < 2.5 s than control)	9%
Patient with cirrhosis (PT > 2.5 s than control)	83%

PT: Prothrombin time.