TY - JOUR
T1 - The incidence and outcome of postoperative hepatic encephalopathy in patients with cirrhosis
AU - Saleh, Zachary M.
AU - Solano, Quintin P.
AU - Louissaint, Jeremy
AU - Jepsen, Peter
AU - Tapper, Elliot B.
N1 - Publisher Copyright:
© 2021 The Authors. United European Gastroenterology Journal published by Wiley Periodicals LLC. on behalf of United European Gastroenterology.
PY - 2021/7
Y1 - 2021/7
N2 - Background: Cirrhosis is associated with increased perioperative risks related to hepatic decompensation. However, data are lacking regarding the incidence and outcomes of postoperative hepatic encephalopathy (HE). Objective: To determine the incidence of HE postoperatively, factors associated with its development, and its association with in-hospital mortality. Methods: Retrospective cohort study of 583 patients with cirrhosis undergoing non-hepatic surgery over a 10-year period. Outcomes included postoperative HE and in-hospital mortality and were, respectively, evaluated using multi-state modeling and Fine-Gray competing risk regression (with postoperative HE as a time-varying covariate). Results: Overall, the median Model for End-Stage Liver Disease Sodium was 10, 61.7% had a history of ascites, 49.9% esophageal varices, and 34.6% HE. The most common surgeries including abdominal/non-bowel (33.3%), orthopedic (18.0%), and bowel (12.2%). A total of 42 (7.2%) patients developed HE postoperatively during admission. The cumulative risk of HE was 7.2%, which was most associated with a history of HE, ASA class, postoperative AKI, and postoperative infection. In-hospital mortality occurred in 34 (5.8%) individuals. Only ASA class was independently associated (HR 2.46, 95%CI 1.21–5.02), but there was a trend for postoperative HE (HR 1.71, 95%CI 0.73–3.98). Discussion: HE is an uncommon but not rare postoperative complication that increases the risk of patient harm. This study implies its development is predictable. Consequently, at-risk patients should have consultation with a hepatologist before undergoing elective surgery.
AB - Background: Cirrhosis is associated with increased perioperative risks related to hepatic decompensation. However, data are lacking regarding the incidence and outcomes of postoperative hepatic encephalopathy (HE). Objective: To determine the incidence of HE postoperatively, factors associated with its development, and its association with in-hospital mortality. Methods: Retrospective cohort study of 583 patients with cirrhosis undergoing non-hepatic surgery over a 10-year period. Outcomes included postoperative HE and in-hospital mortality and were, respectively, evaluated using multi-state modeling and Fine-Gray competing risk regression (with postoperative HE as a time-varying covariate). Results: Overall, the median Model for End-Stage Liver Disease Sodium was 10, 61.7% had a history of ascites, 49.9% esophageal varices, and 34.6% HE. The most common surgeries including abdominal/non-bowel (33.3%), orthopedic (18.0%), and bowel (12.2%). A total of 42 (7.2%) patients developed HE postoperatively during admission. The cumulative risk of HE was 7.2%, which was most associated with a history of HE, ASA class, postoperative AKI, and postoperative infection. In-hospital mortality occurred in 34 (5.8%) individuals. Only ASA class was independently associated (HR 2.46, 95%CI 1.21–5.02), but there was a trend for postoperative HE (HR 1.71, 95%CI 0.73–3.98). Discussion: HE is an uncommon but not rare postoperative complication that increases the risk of patient harm. This study implies its development is predictable. Consequently, at-risk patients should have consultation with a hepatologist before undergoing elective surgery.
KW - HE
KW - MELD-na
KW - hepatic decompensation
KW - hepatic encephalopathy
KW - manuscript info section: liver cirrhosis
KW - mortality
KW - outcome
KW - perioperative risk
KW - postoperative
KW - surgery
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U2 - 10.1002/ueg2.12104
DO - 10.1002/ueg2.12104
M3 - Article
C2 - 34102040
AN - SCOPUS:85107590943
SN - 2050-6406
VL - 9
SP - 672
EP - 680
JO - United European Gastroenterology Journal
JF - United European Gastroenterology Journal
IS - 6
ER -