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 23 February 2018

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News

Effect of liver cirrhosis in patients undergoing laparotomy for trauma

Cirrhotic trauma patients undergoing laparotomy are at high risk of serious complications and death, even after fairly minor injuries, reports October's issue of the Journal of American College of Surgeons.

News image

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Until now there has been little published work on the effect of cirrhosis on outcomes in trauma patients undergoing laparotomy.

Researchers in Los Angeles designed a study to evaluate the risk of death or serious complications in cirrhotic trauma patients undergoing laparotomy as compared with that in a similar group of patients without cirrhosis.

The researchers had access to 46 patients over a 12 year period, with the diagnosis of liver cirrhosis made during laparotomy for trauma.

The group matched each individual patient with 2 noncirrhotic controls on the basis of 7 criteria: age (>55, ≤55 years), gender, mechanism of injury (blunt, penetrating), Injury Severity Score (≤15, 16–25, >25), head Abbreviated Injury Score (<3, ≥3), chest Abbreviated Injury Score (<3, ≥3), and abdominal Abbreviated Injury Score (<3, ≥3).

The researchers excluded 6 cirrhotic patients where matching was not possible.

The group matched each of the remaining 40 patients with 80 noncirrhotic control patients that had been selected from a pool of 4,771 patients who had trauma laparotomies.

Outcomes included mortality, ARDS, pneumonia, renal failure, abdominal sepsis, disseminated intravascular coagulopathy, ICU and hospital stay, and hospital charges.

Overall mortality in the cirrhotic group was significantly higher than that in the matched noncirrhotic group
Journal of the American College of Surgeons

The research group compared outcomes between the two study groups using conditional logistic analysis and derived the hazard ratio and adjusted p value with the stepdown Bonferroni method.

They found that the overall mortality in the cirrhotic group was significantly higher than that in the matched noncirrhotic group (45% versus 24%).

Further analysis showed that mortality in patients with Injury Severity Score ≤15 was 29% in the cirrhotic group and 5% in the noncirrhotic group and in patients with Injury Severity Score 16–25, mortality was 56% and 11%, respectively.

In addition, the incidence of any of the predetermined complications was 45% in the cirrhotic group and 23% in the noncirrhotic group.

The mean surgical ICU stay was 11.5 days and 6.6 days, respectively, and the mean hospital charges were $141,210 and $72,884, respectively.

Dr Demetriades, a co-author of the report, commenting on the report said, "Cirrhotic trauma patients undergoing laparotomy are at high risk of serious complications and death, even after fairly minor injuries."

The group concluded, "This group of patients should be admitted to the ICU for close monitoring and aggressive management irrespective of the severity of injuries."

Journal of the American College of Surgeons; 2004: 199 (4): 538-542
30 September 2004

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