PDF(Pubmed)
Abstract：
UNASSIGNED: 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 transjugular intrahepatic portosystemic shunt (TIPS) placement in patients with cirrhosis is associated with a lower incidence of in-house mortality/liver transplantation (LT) after surgery.
UNASSIGNED: A retrospective database search for the years 2010-2020 was carried out. We identified 64 patients with cirrhosis who underwent surgery within 3 months after TIPS placement and 131 patients with cirrhosis who underwent surgery without it (controls). Operations were categorised into low-risk and high-risk procedures. The primary endpoint was in-house mortality/LT. We analysed the influence of high-risk surgery, preoperative TIPS placement, age, sex, baseline creatinine, presence of ascites, Chronic Liver Failure Consortium Acute Decompensation (CLIF-C AD), American Society of Anesthesiologists (ASA), and model for end-stage liver disease (MELD) scores on in-house mortality/LT by multivariable Cox proportional hazards regression.
UNASSIGNED: In 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% CI 0.19-1.00) on multivariable analysis.
UNASSIGNED: A preoperative TIPS might be associated with reduced postoperative in-house mortality in selected patients with cirrhosis.
UNASSIGNED: Patients with cirrhosis are at risk for more complications and a higher mortality after surgical procedures. A transjugular intrahepatic portosystemic shunt (TIPS) is used to treat complications of cirrhosis, but it is unclear if it also helps to lower the risk of surgery. This study takes a look at complications and mortality of patients undergoing surgery with or without a TIPS, and we found that patients with a TIPS develop less complications and have an improved survival. Therefore, a preoperative TIPS should be considered in selected patients, especially if indicated by ascites.
UNASSIGNED: A retrospective database search for the years 2010-2020 was carried out. We identified 64 patients with cirrhosis who underwent surgery within 3 months after TIPS placement and 131 patients with cirrhosis who underwent surgery without it (controls). Operations were categorised into low-risk and high-risk procedures. The primary endpoint was in-house mortality/LT. We analysed the influence of high-risk surgery, preoperative TIPS placement, age, sex, baseline creatinine, presence of ascites, Chronic Liver Failure Consortium Acute Decompensation (CLIF-C AD), American Society of Anesthesiologists (ASA), and model for end-stage liver disease (MELD) scores on in-house mortality/LT by multivariable Cox proportional hazards regression.
UNASSIGNED: In 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% CI 0.19-1.00) on multivariable analysis.
UNASSIGNED: A preoperative TIPS might be associated with reduced postoperative in-house mortality in selected patients with cirrhosis.
UNASSIGNED: Patients with cirrhosis are at risk for more complications and a higher mortality after surgical procedures. A transjugular intrahepatic portosystemic shunt (TIPS) is used to treat complications of cirrhosis, but it is unclear if it also helps to lower the risk of surgery. This study takes a look at complications and mortality of patients undergoing surgery with or without a TIPS, and we found that patients with a TIPS develop less complications and have an improved survival. Therefore, a preoperative TIPS should be considered in selected patients, especially if indicated by ascites.
摘要：
■肝硬化与手术发病率和死亡率增加有关。门脉高压和手术类型已被确定为术后结局的关键决定因素。我们旨在评估以下假设：肝硬化患者术前经颈静脉肝内门体分流术（TIPS）的放置与术后内部死亡率/肝移植（LT）的发生率较低有关。
■进行了2010-2020年的回顾性数据库搜索。我们确定了64例肝硬化患者在TIPS放置后3个月内接受手术治疗，而131例肝硬化患者接受了手术治疗（对照）。操作分为低风险和高风险程序。主要终点是内部死亡率/LT。我们分析了高风险手术的影响，术前TIPS放置,年龄,性别,基线肌酐,腹水的存在，慢性肝功能衰竭联盟急性失代偿（CLIF-CAD），美国麻醉师协会（ASA），和通过多变量Cox比例风险回归分析的终末期肝病（MELD）内部死亡率/LT评分模型。
■在TIPS和对照组中，大多数患者表现为Child-PughB期(37/64，58%与70/131，53%）在手术时，但TIPS队列中的MELD评分中位数较高(14vs.11分)。在这两个队列中，低风险和高风险程序分别为47％和53％。TIPS队列中内部死亡率/LT的发生率较低（12/64，19%vs.52/131，40%），当进一步细分为低风险时(0/30，0%与10/61，16%）和高风险手术（12/34，35%vs.42/70，60%）。在多变量分析中，术前TIPS放置与术后内部死亡率/LT的较低比率相关（风险比0.44，95％CI0.19-1.00）。
■术前TIPS可能与部分肝硬化患者术后内部死亡率降低相关。
肝硬化患者在手术后有更多并发症和更高死亡率的风险。经颈静脉肝内门体分流术（TIPS）用于治疗肝硬化并发症，但目前尚不清楚它是否也有助于降低手术风险。这项研究着眼于在有或没有TIPS的情况下接受手术的患者的并发症和死亡率，我们发现TIPS患者的并发症较少，生存率提高。因此,在选定的患者中，应考虑术前TIPS，尤其是腹水。
■进行了2010-2020年的回顾性数据库搜索。我们确定了64例肝硬化患者在TIPS放置后3个月内接受手术治疗，而131例肝硬化患者接受了手术治疗（对照）。操作分为低风险和高风险程序。主要终点是内部死亡率/LT。我们分析了高风险手术的影响，术前TIPS放置,年龄,性别,基线肌酐,腹水的存在，慢性肝功能衰竭联盟急性失代偿（CLIF-CAD），美国麻醉师协会（ASA），和通过多变量Cox比例风险回归分析的终末期肝病（MELD）内部死亡率/LT评分模型。
■在TIPS和对照组中，大多数患者表现为Child-PughB期(37/64，58%与70/131，53%）在手术时，但TIPS队列中的MELD评分中位数较高(14vs.11分)。在这两个队列中，低风险和高风险程序分别为47％和53％。TIPS队列中内部死亡率/LT的发生率较低（12/64，19%vs.52/131，40%），当进一步细分为低风险时(0/30，0%与10/61，16%）和高风险手术（12/34，35%vs.42/70，60%）。在多变量分析中，术前TIPS放置与术后内部死亡率/LT的较低比率相关（风险比0.44，95％CI0.19-1.00）。
■术前TIPS可能与部分肝硬化患者术后内部死亡率降低相关。
肝硬化患者在手术后有更多并发症和更高死亡率的风险。经颈静脉肝内门体分流术（TIPS）用于治疗肝硬化并发症，但目前尚不清楚它是否也有助于降低手术风险。这项研究着眼于在有或没有TIPS的情况下接受手术的患者的并发症和死亡率，我们发现TIPS患者的并发症较少，生存率提高。因此,在选定的患者中，应考虑术前TIPS，尤其是腹水。
