Abstract

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.

Original languageEnglish (US)
Pages (from-to)986-991
Number of pages6
JournalAnnals of surgery
Volume263
Issue number5
DOIs
StatePublished - Jan 1 2016

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Portal Hypertension
Esophageal and Gastric Varices
End Stage Liver Disease
Mortality
Morbidity
Quality Improvement
Liver Diseases

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

@article{f305f618dc6a471f80a9ef5063b6bdf0,
title = "Portal hypertension. An underestimated entity?",
abstract = "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.",
author = "Zakiyah Kadry and Schaefer, {Eric W.} and Shah, {Riaz Ali} and Karen Krok and Ping Du and Dmitri Bezinover and Piotr Janicki and Ashokkumar Jain and Gusani, {Niraj J.} and Ian Schreibman and Hollenbeak, {Christopher S.} and {Riley III}, Thomas",
year = "2016",
month = "1",
day = "1",
doi = "10.1097/SLA.0000000000001299",
language = "English (US)",
volume = "263",
pages = "986--991",
journal = "Annals of Surgery",
issn = "0003-4932",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

TY - JOUR

T1 - Portal hypertension. An underestimated entity?

AU - Kadry, Zakiyah

AU - Schaefer, Eric W.

AU - Shah, Riaz Ali

AU - Krok, Karen

AU - Du, Ping

AU - Bezinover, Dmitri

AU - Janicki, Piotr

AU - Jain, Ashokkumar

AU - Gusani, Niraj J.

AU - Schreibman, Ian

AU - Hollenbeak, Christopher S.

AU - Riley III, Thomas

PY - 2016/1/1

Y1 - 2016/1/1

N2 - 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.

AB - 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.

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U2 - 10.1097/SLA.0000000000001299

DO - 10.1097/SLA.0000000000001299

M3 - Article

C2 - 26181478

AN - SCOPUS:84963517259

VL - 263

SP - 986

EP - 991

JO - Annals of Surgery

JF - Annals of Surgery

SN - 0003-4932

IS - 5

ER -