Key factors of therapeutic effects for surgery in patients with cirrhotic portal hypertension

OBJECTIVE: In the clinical management of cirrhotic por tal hyper tension, surgery is often necessary; however, the operative mortality rate is high. PATIENTS AND METHODS: Data from 161 patients, who underwent surgery for cirrhotic portal hypertension, were analyzed, and 24 potential predictors of surgical outcome were assessed. A Kruskal-Wallis rank sum test was used for single-factor comparisons, and multivariate logistic regression for multifactor comparisons to identify key factors for poor surgical outcomes and calculate their scores. RESULTS: Six predictors of poor surgical outcomes were identified: postoperative bleeding within 30 h of > 2 L, with a score of 3; severe liver atrophy (an anteroposterior diameter of the left lobe of <= 55 mm and an oblique diameter of the right lobe <= 110 mm), with a score of 3; a base excess of < -3 mmol/L, with a score of 3; a platelet count of < 3 T/L, with a score of 2; an amount of intraoperative bleeding of > 2 L, with a score of 2; and a red blood cell count of < 3 G/L, with a score of 1. For patients with good outcome (n = 147), all patients had a score of <= 3, except one patient who had a score of 4. With respect to patients who died (n = 14), all had a score of >= 5, except one patient who had a score of 4. A significant difference was observed between the two groups (p < 0.05). The mortality was 100% in patients with a score of >= 7. CONCLUSIONS: Six key factors for poor surgical outcomes were identified in this study. Operative mortality appears to be significantly increased in patients with a score of 5-6. Surgery should be contraindicated in patients with a score of >= 7. To reduce mortality, close attention should be paid to preoperative and intraoperative treatment and prevention to achieve a score of < 4.