Brain surgery in patients with liver cirrhosis: Clinical article

Ching Chang Chen, Peng Wei Hsu, Shih Tseng Lee, Chen Nen Chang, Kuo Chen Wei, Chieh Tsai Wu, Yung Hsin Hsu, Tzu Kang Lin, Sai Cheung Lee, Yin Cheng Huang*

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

33 Scopus citations

Abstract

Object. Liver cirrhosis was identified as an independent predictor of poor outcomes in patients suffering trauma and in those undergoing major surgeries. The aim of this study was to report the authors' experiences treating patients with cirrhosis who undergo brain surgeries. Methods. Between 2004 and 2009, 121 consecutive patients with cirrhosis underwent 144 brain procedures. Patients were categorized as Child-Turcotte-Pugh (referred to as "Child") Class A, B, or C. The patient profiles, including the severity of cirrhosis, reason for surgery, complications, and prognosis factors, were analyzed. Results. In this retrospective study, the overall surgical complication rate for patients with cirrhosis was 52.1% and the mortality rate was 24.3%. For patients with acute traumatic brain injury (TBI), the complication, rebleeding, and mortality rates reached 84.4%, 68.8%, and 37.5%, respectively. Surgery for TBI was a significant risk factor for postoperative complications (p = 0.0002) and postoperative hemorrhage (p < 0.0001). Otherwise, according to the Child classification, the complication rate increased in a stepwise fashion from 38.7% to 60% to 84.2%, the rebleeding rate from 29.3% to 48.0% to 63.2%, and the mortality rate from 5.3% to 38% to 63.2% for Child A, B, and C, respectively. The Child classification was associated with higher risk of complications - Child B vs A OR 2.84 (95% CI 1.28-6.29), Child C vs A OR 5.39 (95% CI 1.32-22.02). It was also associated with risk of death - Child C vs A OR 30.43 (95% CI 7.71-120.02), Child B vs A OR 10.88 (95% CI 3.42-34.63). Conclusions. Liver cirrhosis is a poor comorbidity factor for brain surgery. The authors' results suggest that the Child classification used independently is a poor prognostic factor; in addition, grave outcomes were observed in patients with TBI.

Original languageEnglish
Pages (from-to)348-353
Number of pages6
JournalJournal of Neurosurgery
Volume117
Issue number2
DOIs
StatePublished - 08 2012

Keywords

  • Brain surgery
  • Child-Turcotte-Pugh class
  • Complication
  • Liver cirrhosis
  • Neurosurgery
  • Prognostic factor

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