Outcomes in patients with portal hypertension undergoing gastrointestinal surgery: A propensity score matched analysis from the NSQIP dataset

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From: The American Journal of Surgery(Vol. 217, Issue 4)
Publisher: Elsevier B.V.
Document Type: Article
Length: 345 words

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Abstract :

Highlights * Portal hypertension (PH) increased the risk of morbidity, mortality, and critical complications after gastrointestinal surgery. * Patients with PH were associated with increased transfusion rates. * PH was associated with 2-fold increased mortality and 40% increased risk of critical care complications after PSM. Abstract Background/Aim We aim to study the impact of PH in patients undergoing gastrointestinal surgery (GI). Methods We queried the ACS-NSQIP database from 2005 through 2010 for patients undergoing GI surgery with PH. Esophageal varices (EV) diagnosis was used as a surrogate of PH. Results A total of 192,296 patients underwent GI surgery, of which 379 had PH. Regression analyses revealed that patients with PH had a 6-fold (95% CI 4.6--7.9) increase in 30-day mortality, a 3-fold (95% CI 2.5--3.7) increase in morbidity, a 3.2-fold (95% CI 2.6--3.9) increase in critical care complications (CCC), and a 6.5-day (95% CI 5.1--7.8) increase in hospital LOS. After PSM, the impact of PH on the outcomes remained. These differences were significant regardless of the emergent or elective status of the procedure. AUC analysis demonstrated that MELD and MELDNa + score greater than 10.5 was the most predictive of peri-operative mortality in elective PH cases. Conclusions PH is associated with an increased risk of poor surgical outcomes in patients undergoing elective and emergent gastrointestinal surgery. Abbreviations PH, Portal Hypertension; GI, Gastrointestinal; EV, Esophageal varices; LOS, Length of stay; PSM, Propensity score match; AUC, Area under the curve; MELD, Model of End Stage liver disease; CCC, Critical care complications; LOS, Length of stay; ACS-NSQIP, American College of Surgeons National Surgical Quality Improvement Program; PUFS, ACS-NSQIP Participant Use Files Author Affiliation: Department of Surgery - Transplant Division, University of Kentucky, College of Medicine, Lexington, KY, 40536, USA * Corresponding author. 800 Rose Street, Room C453, Lexington, KY, 40536-0293, USA. Article History: Received 13 July 2018; Revised 5 December 2018; Accepted 10 December 2018 (footnote)1 These co-authors have contributed equally to the production of this article. Byline: Felice De Stefano (1), Catherine R. Garcia (1), Meera Gupta, Francesc Marti, Lilia Turcios, Adam Dugan, Roberto Gedaly [rgeda2@uky.edu] (*)

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Gale Document Number: GALE|A578190885