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• W4386989382 abstract "Background & AimsLiver cirrhosis is associated with an increased surgical morbidity and mortality. Portal hypertension and the surgery type have been established as critical determinants of postoperative outcome. We aim to evaluate the hypothesis that preoperative TIPS-placement in patients with liver cirrhosis is associated with a lower incidence of in-house mortality/liver transplantation (LT) after surgery.MethodsA retrospective database search for the years 2010 – 2020 was carried out. We identified 64 patients with liver cirrhosis who underwent surgery within three months after TIPS-placement and 131 cirrhosis patients who underwent surgery without it (control). Operations were categorized into low-risk and high-risk procedures. The primary endpoint was in-house mortality/LT. We analyzed the influence of high-risk surgery, preoperative TIPS-placement, age, sex, baseline creatinine, presence of ascites, CLIF-C AD, ASA and MELD scores on in-house mortality/LT by multivariable Cox proportional hazards regression.ResultsIn both the TIPS and the control cohort, most patients presented with a Child-Pugh B stage (37/64, 58% vs. 70/131, 53%) at the time of surgery, but the median MELD score was higher in the TIPS cohort (14 vs. 11 points). Low-risk and high-risk procedures amounted to 47% and 53% in both cohorts. The incidence of in-house mortality/LT was lower in the TIPS cohort (12/64, 19% vs. 52/131, 40%), also when further subdivided into low-risk (0/30, 0% vs. 10/61, 16%) and high-risk surgery (12/34, 35% vs. 42/70, 60%). Preoperative TIPS-placement was associated with a lower rate for postoperative in-house mortality/LT (hazard ratio 0.44, 95%-confidence interval 0.19 – 1.00) on multivariable analysis.ConclusionsA preoperative TIPS might be associated with reduced postoperative in-house mortality in selected patients with liver cirrhosis." @default.
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• W4386989382 date "2023-09-01" @default.
• W4386989382 modified "2023-09-30" @default.
• W4386989382 title "Preoperative TIPS and in-hospital mortality in patients with cirrhosis undergoing surgery" @default.
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• W4386989382 doi "https://doi.org/10.1016/j.jhepr.2023.100914" @default.
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