TY - JOUR
T1 - Complications associated with instrumented lumbar surgery in patients with liver cirrhosis
T2 - A matched cohort analysis
AU - Liao, Jen Chung
AU - Chen, Wen Jer
AU - Chen, Lih Hui
AU - Niu, Chi Chien
AU - Fu, Tsai Shen
AU - Lai, Po Liang
AU - Tsai, Tsung Ting
PY - 2013/8
Y1 - 2013/8
N2 - Background: There is no information in the English literature on the outcome of liver cirrhotic patients who have undergone instrumented lumbar surgery. Purpose: To review the results of instrumented lumbar surgery in patients with liver cirrhosis and determine the surgical risk factors in this group of patients. Study design: A retrospective study for comparison between two cohorts (liver cirrhosis vs. nonliver cirrhosis). Patient sample: Fifty-eight patients. Outcome measures: Child-Turcotte-Pugh scale was used to assess the patients' hepatic functional reserve. The clinical outcomes were evaluated by the five-grade patient-centered general outcome assessment questionnaire. Any event that led to reoperation, requirement of intensive care, prolonging of the hospital stay (more than 14 days), or admission after discharge within 30 days of surgery was defined as a perioperative complication. Methods: Between 1997 and 2009, patients with liver cirrhosis who had undergone instrumented lumbar surgeries for degenerative lumbar disease were studied. All data were compared with those for gender-, age-, and diagnosis-matched nonliver cirrhosis patients. Results: Liver cirrhotic patients had significantly lower preoperative hemoglobin, white blood cell counts, platelets, and albumin levels and higher prothrombin time and bilirubin level. Instrumented lumbar surgery was associated with significantly more blood loss, a longer hospital stay, and more complications in patients with liver cirrhosis compared with control patients. The final satisfactory rate was higher in the control group but without statistical difference (85% vs. 65%, p=.240). In the cirrhotic group, 22 patients (76%) were Child Class A and 7 patients (24%) were Child Class B; 12 patients developed one or more complications. Patients with Child Class B had a significantly higher incidence of complications than those with Child Class A (p=.006). In patients with Child Class A, those with a score of 6 also had a significantly higher incidence of complications than those with a score of 5 (p<.001). Female gender (p=.035), a low level of albumin (p=.002), presence of ascites (p=.029), and increased blood loss (p=.044) were associated with a higher risk of complications. Conclusions: The rate of complications after instrumented lumbar surgery was significantly higher in patients with cirrhosis than in control patients, especially in those with 6 or more Child-Turcotte-Pugh points. The surgeon should counsel these patients on the possibility of developing early complications. Several factors were associated with surgical complications and should be addressed by the spine surgeons before or when they perform these elective instrumented lumbar surgeries.
AB - Background: There is no information in the English literature on the outcome of liver cirrhotic patients who have undergone instrumented lumbar surgery. Purpose: To review the results of instrumented lumbar surgery in patients with liver cirrhosis and determine the surgical risk factors in this group of patients. Study design: A retrospective study for comparison between two cohorts (liver cirrhosis vs. nonliver cirrhosis). Patient sample: Fifty-eight patients. Outcome measures: Child-Turcotte-Pugh scale was used to assess the patients' hepatic functional reserve. The clinical outcomes were evaluated by the five-grade patient-centered general outcome assessment questionnaire. Any event that led to reoperation, requirement of intensive care, prolonging of the hospital stay (more than 14 days), or admission after discharge within 30 days of surgery was defined as a perioperative complication. Methods: Between 1997 and 2009, patients with liver cirrhosis who had undergone instrumented lumbar surgeries for degenerative lumbar disease were studied. All data were compared with those for gender-, age-, and diagnosis-matched nonliver cirrhosis patients. Results: Liver cirrhotic patients had significantly lower preoperative hemoglobin, white blood cell counts, platelets, and albumin levels and higher prothrombin time and bilirubin level. Instrumented lumbar surgery was associated with significantly more blood loss, a longer hospital stay, and more complications in patients with liver cirrhosis compared with control patients. The final satisfactory rate was higher in the control group but without statistical difference (85% vs. 65%, p=.240). In the cirrhotic group, 22 patients (76%) were Child Class A and 7 patients (24%) were Child Class B; 12 patients developed one or more complications. Patients with Child Class B had a significantly higher incidence of complications than those with Child Class A (p=.006). In patients with Child Class A, those with a score of 6 also had a significantly higher incidence of complications than those with a score of 5 (p<.001). Female gender (p=.035), a low level of albumin (p=.002), presence of ascites (p=.029), and increased blood loss (p=.044) were associated with a higher risk of complications. Conclusions: The rate of complications after instrumented lumbar surgery was significantly higher in patients with cirrhosis than in control patients, especially in those with 6 or more Child-Turcotte-Pugh points. The surgeon should counsel these patients on the possibility of developing early complications. Several factors were associated with surgical complications and should be addressed by the spine surgeons before or when they perform these elective instrumented lumbar surgeries.
KW - Child-Turcotte-Pugh score
KW - Complications
KW - Degenerative lumbar disease
KW - Instrumented lumbar surgery
KW - Liver cirrhosis
UR - http://www.scopus.com/inward/record.url?scp=84881135195&partnerID=8YFLogxK
U2 - 10.1016/j.spinee.2013.02.028
DO - 10.1016/j.spinee.2013.02.028
M3 - 文章
C2 - 23541455
AN - SCOPUS:84881135195
SN - 1529-9430
VL - 13
SP - 908
EP - 913
JO - Spine Journal
JF - Spine Journal
IS - 8
ER -