Elective colorectal surgery in those with cirrhosis: a population-based study assessing practice patterns and patient outcomes

Abstract

Abstract Background Patients with cirrhosis have significant postoperative risks following major abdominal surgery. Historic literature and prediction tools do not reflect current practices and outcomes. An assumed 30-day mortality by the model for end-stage liver disease (MELD) score of <12 and 12+ in patients undergoing abdominal surgery is 8% and 33%, respectively. The study objectives were to describe relevant practice patterns and postoperative outcomes in cirrhosis after elective colorectal surgery. Methods This retrospective cohort study included 1439 individuals in Ontario with a diagnosis of cirrhosis who underwent colorectal surgery from 2009 to 2017. Demographics, cirrhosis-specific characteristics, and outcomes were identified using linked administrative databases. Univariable and multivariable analyses were performed. Results The median MELD-Sodium score was 8 (IQR 7-11). The most common cirrhosis etiologies were metabolic dysfunction-associated steatotic liver disease (58%) and alcohol-associated (24%). Indications for surgery included colorectal cancer (70%), diverticulitis (11%), and inflammatory bowel disease (10%). The 3 most common procedures performed were colon resection with primary anastomosis (66%), rectal resection with primary anastomosis (17%), and abdominal perineal resection (6%). In-hospital and 90-day mortality were 5% and 7%, respectively. Ninety-day complications included readmission (24%), emergency department visit (39%), intensive care admission (27%), and hepatic decompensation (6%). Ninety-day mortality based on MELD-Sodium score included 6% versus 21% in those with a score <12 compared to 12+. Alcohol-related cirrhosis, age, and comorbidities were associated with mortality (P < .01). Conclusion This work confirms that the increased surgical risks are lower than once believed in patients with cirrhosis undergoing colorectal surgery in the elective setting. This evidence will guide management of patients in this high-risk group.