Portal hypertension. An underestimated entity?

Objective: The aim of this study is to evaluate portal hypertension as an independent risk factor in general surgical procedures. Background: Data on the impact of portal hypertension in general surgical outcomes has been limited. Published literature has focused mainly on its effect in liver surgery. The Child Pugh score and Model for End Stage Liver Disease are utilized for surgical risk assessment in liver disease but they do not accurately reflect degree of portal hypertension. Methods: From 2005 to 2012, patients with esophageal varices (EV) in the National Surgical Quality Improvement Program (NSQIP) formed the portal hypertension cohort, and were case matched to patients without esophageal varices (NEV) based on sex, age, surgery type, and year of operation. Thirty day mortality and morbidity were analyzed using generalized estimating equations for binary outcomes. EV patients were also dichotomized by Model for End Stage Liver Disease (MELD) score (≥15 vs >15) and compared with NEV patients. Results: One thousand five hundred and seventy-four EV patients were matched to 3148 NEV patients. In multivariable analysis, EV patients had a 3.01 higher odds of 30 day mortality (P<0.001) and 1.28 higher odds of complications (P<0.001) compared with NEV patients. EV patients with MELD >15 had 4.64 higher odds of death within 30 days (P<0.001) and had 1.75 higher odds of complications within 30 days (P<0.001) compared with NEV patients; EV patients with MELD 15 or less had 1.95 higher odds of 30 day mortality (P<0.001) compared with NEV patients. Conclusions: Portal hypertension is associated with a significant mortality and morbidity risk in general surgery, and should not be underestimated even in patients withMELD15 or less where the earlymortality risk remained significant.