Postoperative mortality in patients with liver cirrhosis undergoing transurethral resection of the prostate: a Danish nationwide cohort study

Abstract

Objective To examine the risk of 30‐day postoperative mortality from transurethral resection of the prostate (TURP) in patients with liver cirrhosis, who are reportedly at considerably increased perioperative risk. Patients and methods For the period 1 January 1977 to 31 December 1993, a population‐based cohort was identified comprising Danish patients diagnosed with liver cirrhosis and a random sample of Danes also undergoing TURP. Logistic regression models were used to estimate the association between liver cirrhosis, age, type of admission, comorbidity and 30‐day mortality. Results In a cohort of 23 133 patients with liver cirrhosis, 30 underwent TURP; 150 controls with no liver cirrhosis also underwent the same procedure. Of the patients with liver cirrhosis, 6.7% died within 30 days of TURP; the estimated adjusted odds ratio was 3.0 (95% confidence interval 0.4–22.9) for the 30‐day postoperative mortality in patients with liver cirrhosis compared with patients without (mortality 2%). Advanced age, comorbidity and acute admission seemed to be associated with an increased postoperative mortality. Conclusion This study indicates that TURP in patients with liver cirrhosis was associated with increased mortality.

Cirrhosis patients have increased risk of complications after hip or knee arthroplasty

“…In other types of surgery, odds ratios for 30-day mortality for cirrhosis patients relative to population controls have ranged from 3 to 12 ( Poulsen et al 2000 , Nielsen et al 2001 , Thulstrup et al 2001 , Nielsen et al 2002 , Lund et al 2003 , Arif et al 2012 ), the lowest odds ratio being for transurethral resection of the prostate ( Nielsen et al 2001 ) and the highest being for open cholecystectomy ( Thulstrup et al 2001 ). So, although THA and TKA are extra-abdominal procedures performed in an elective setting, the relative increase in mortality ascribed to cirrhosis is comparable to that seen after other types of surgery.…”

Minimum platelet count threshold before invasive procedures in cirrhosis: Evolution of the guidelines

“…Regarding urological surgery[ 111 , 112 ], cholecystectomy, and herniotomy[ 113 - 117 ], the available evidence is not enough to assess the association between platelet count and postprocedural bleeding risk because of the wide heterogeneity in the management of blood coagulation parameters in the preprocedural phases of surgical interventions.…”

Procedure‐related bleeding risk in patients with cirrhosis and severe thrombocytopenia

“…Furthermore, the available studies did not evaluate this association. [60][61][62][63][64] Finally, also the available evidence related to thoracentesis 65,66 and urological surgery 67,68 was not sufficient to assess the association between platelet count and post-procedural bleeding risk.…”

“…Since in the Position Paper AISF/SIMI selection criteria were not specified, we assumed they were the same ones we applied in our literature search. Therefore, the 15 studies, which met the inclusion criteria, 9‐23 were analysed together with those identified by the working group AISF/SIMI 24‐68 …”