Background: The aim of this study is to review systematically morbidity and mortality after non-hepatic surgery in patients with liver cirrhosis. Methods: Comprehensive searches were conducted in PubMed, Embase and the Cochrane Library for articles using the words: liver failure, hepatic insufficiency, liver cirrhosis, cirrhosis, cirrhotic, surgical procedures, operative complications, operative mortality, postoperative complications, surgical complication, surgical risk, hernia. Results: Forty-six articles were selected from 5247 included after the initial search. Level of evidence provided in the articles varied greatly. Non-hepatic surgery of patients with cirrhosis resulted in increased postoperative morbidity and mortality compared to similar surgery for non-cirrhotic patients. Cholecystectomy and umbilical and inguinal hernia correction were associated with the lowest increased morbidity and mortality while pancreatic surgery, cardiovascular, and trauma surgery correlated with the highest. The preoperative model for end stage liver disease (MELD) and Child-Turcotte-Pugh (CTP) scores appeared to be predictive of postoperative risks. Portal hypertension and surgery in the emergency setting were associated with extra increased mortality and morbidity rates. Conclusion: This systematic review of the literature showed that in patients with liver cirrhosis who undergo non-hepatic surgery, postoperative morbidity and mortality rates varied greatly depending on severity of the cirrhosis and the surgical procedure. However, the majority of procedures can be safely performed in patients with low MELD scores or CTP A cirrhosis without portal hypertension.

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Best Practice and Research in Clinical Gastroenterology
Department of Surgery

de Goede, B, Klitsie, P.J, Lange, J.F, Metselaar, H.J, & Kazemier, G. (2012). Morbidity and mortality related to non-hepatic surgery in patients with liver cirrhosis; A systematic review. Best Practice and Research in Clinical Gastroenterology, 26(1), 47–59. doi:10.1016/j.bpg.2012.01.010