The Impact of Chronic Liver Disease on Postoperative Outcomes and Resource Utilization

Abstract

Background

Multiple studies have shown high rates of postoperative morbidity and mortality in individuals with chronic liver disease (CLD). However, analyses from comparisons with individuals without CLD are not available. Such analyses might provide opportunities to improve outcomes.

Methods

Data from The National Surgical Quality Improvement Program (NSQIP) from 2008 to 2011 were analyzed comparing CLD patients undergoing non-liver surgery propensity matched to those without CLD. Patients with CLD were stratified by Model of End Stage Liver Disease (MELD) scores <15 and ≥15. Primary outcome was all cause mortality, and secondary outcomes were composite and individual morbidity, hospital length of stay, readmission, reoperation, and discharge destination. Odds ratios (OR) were calculated, and length of hospital stay was estimated using Poisson regression.

Results

There were 6,209 patients with CLD (4,013 with low MELD, 2,196 with high MELD) matched to 18,627 patients without. Patients with CLD had 1.8- and 3.3-times higher odds of mortality (95% CI 1.6–2.1 for Low MELD (10.6%), 2.9–3.8 for high MELD (35.2%), and 1.8- and 2.2-times higher odds of any morbidity (1.6–1.9 and 1.9–2.4). Complications specific to CLD were increased based on MELD specifically coma (OR 1.6, 0.9–2.9 for Low MELD, 2.2, 1.5–3.2 for High MELD), renal failure (OR 1.4, 1.1–1.8 and 2.4, 2.0–2.9), and bleeding (OR 1.7, 1.5–1.9 and 2.0, 1.8–2.3). They also had a 20% and 80% longer length of stay, 2.2- and 3.4-times higher odds of being discharged somewhere other than home, 1.7- and 1.6-times higher odds of readmission, and 1.5- and 1.6-times higher odds of reoperation.

Conclusion

Patients with CLD have significantly higher odds of mortality and morbidity, which is increased with a higher MELD. Interventions that decrease those morbidities are needed and have the potential to decrease mortality and resource utilization.

Keywords:

• National Surgical Quality Improvement Program
• chronic liver disease
• outcomes

View addendum:

Management of Patients with Chronic Liver Disease in the Perioperative Period

Declaration of Interest

Dr. Oliver, Dr. Merchant, and Dr. Koneru all reported no biomedical financial interests or potential conflicts of interest. There was no funding for this project.