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  • Title: Liver cirrhosis in patients undergoing laparotomy for trauma: effect on outcomes.
    Author: Demetriades D, Constantinou C, Salim A, Velmahos G, Rhee P, Chan L.
    Journal: J Am Coll Surg; 2004 Oct; 199(4):538-42. PubMed ID: 15454135.
    Abstract:
    BACKGROUND: There is little published work on the effect of cirrhosis on outcomes in trauma patients undergoing laparotomy. The aim of this study was 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. STUDY DESIGN: During a 12-year period, there were 46 patients with the diagnosis of liver cirrhosis made during laparotomy for trauma. Each patient was matched with two 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). Six cirrhotic patients were excluded because matching was not possible. The remaining 40 patients were matched with 80 noncirrhotic control patients 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. Outcomes between the two study groups were compared with conditional logistic analysis. Hazard ratio (95% CI) and adjusted p value with the stepdown Bonferroni method were derived. RESULTS: The overall mortality in the cirrhotic group was significantly higher than that in the matched noncirrhotic group (45% versus 24%, hazard ratio: 7.60 [2.00, 28.94], p = 0.021). Mortality in patients with Injury Severity Score </=15 was 29% in the cirrhotic group and 5% in the noncirrhotic group (p = 0.013) and in patients with Injury Severity Score 16-25, mortality was 56% and 11%, respectively (p = 0.024). The incidence of any of the predetermined complications was 45% in the cirrhotic group and 23% in the noncirrhotic group (p = 0.110). The mean surgical ICU stay was 11.5 days and 6.6 days, respectively (p = 0.037), and the mean hospital charges were $141,210 and $72,884, respectively (p = 0.031). CONCLUSIONS: Cirrhotic trauma patients undergoing laparotomy are at high risk of serious complications and death, even after fairly minor injuries. This group of patients should be admitted to the ICU for close monitoring and aggressive management irrespective of the severity of injuries.
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