Ziser et al identified risk factors associated with perioperative complications and long term mortality in patients with cirrhosis who underwent surgery. Most of the risk factors can be identified prior to surgery. The authors are from the Mayo Clinic.
Parameters:
(1) gender
(2) Child-Pugh score
(3) ascites
(4) cause of cirrhosis
(5) serum creatinine level
(6) chronic obstructive pulmonary disease (COPD)
(7) preoperative infection
(8) preoperative upper GI bleeding
(9) ASA physical status rating
(10) degree of surgical severity
(11) surgery on the respiratory system
(12) intraoperative hypotension
|
Parameter |
Finding |
Points |
|
gender |
female |
0 |
|
|
male |
1 |
|
Child-Pugh score |
0 to 6 (Class A) |
0 |
|
|
7 to 12 (Class B or C) |
1 |
|
ascites |
absent |
0 |
|
|
present |
1 |
|
cause of cirrhosis (A) |
primary biliary cirrhosis |
0 |
|
|
not primary biliary cirrhosis |
1 |
|
cause of cirrhosis (B) |
not cryptogenic |
0 |
|
|
cryptogenic |
1 |
|
serum creatinine |
normal |
0 |
|
|
elevated (male > 1.2 mg/dL; female > 0.6 mg/dL) |
1 |
|
COPD |
absent |
0 |
|
|
present |
1 |
|
preoperative infection |
absent |
0 |
|
|
present |
1 |
|
preoperative upper GI bleeding |
absent |
0 |
|
|
present |
1 |
|
ASA physical status rating |
1, 2 or 3 |
0 |
|
|
4 or 5 |
1 |
|
degree of surgical severity |
low or moderate tissue injury |
0 |
|
|
severe tissue injury |
1 |
|
surgery on the respiratory system |
no |
0 |
|
|
yes |
1 |
|
intraoperative hypotension |
absent |
0 |
|
|
present |
1 |
score for perioperative complications =
= SUM(items 2, 3, 4A, 5, 6, 7, 8, 9, 10, 12)
score for long term mortality =
= SUM(items 1, 2, 3, 4B, 5, 7, 9, 11)
Interpretation:
• minimum score: 0
• maximum perioperative complication score: 10
• maximum long term mortality score: 8
|
Number of Risk Factors |
Percent with Complications |
|
0 |
2% |
|
1 |
9% |
|
2 |
15% |
|
3 |
33% |
|
4 |
63% |
|
5 |
63% |
|
6 |
74% |
|
>= 7 |
100% |
from Figure 1, page 48
|
Number of Risk Factors |
1 Year Mortality Rate |
5 Year Mortality Rate |
|
0 |
2% |
42% |
|
1 |
3% |
60% |
|
2 |
24% |
70% |
|
3 |
35% |
82% |
|
4 |
58% |
90% |
|
5 |
72% |
95% |
|
6 or 7 |
85% |
100% |
from Figure 3, page 52
Purpose: To evaluate the perioperative and long term mortality risk for a patient with cirrhosis who undergoes surgery using the risk factors of Ziser et al.
Specialty: Gastroenterology, General Surgery, Orthopedic Surgery
Objective: risk factors, severity, prognosis, stage, complications, surgery
ICD-10: K74.6,
