Operative timing and patient survival following distal splenorenal shunt

Pomerantz, R.A.; Eckhauser, F.E.; Knol, J.A.; Guirre, K.; Raper, S.E.; Turcotte, J.G.

American Surgeon 55(6): 333-337

1989


ISSN/ISBN: 0003-1348
PMID: 2729767
Document Number: 347238
The importance of "operative timing" in cirrhotic patients with variceal hemorrhage is often underemphasized. To evalute the effects of immediate versus delayed selective portasystemic decompresssion on hepatic function, operative mortality, and long-term patient survival, we reviewed the records of 77 patients who underwent distal splenorenal shunts (DSRS) over a 14-year period. A hepatic risk status score was calculated at the time of the index bleed (HRS1) or presentation and again just prior to operation (HRS2). Variables analyzed included age, sex, prior bleeding episodes, time from index bleed to operation, transfusion requirements, and etiology of cirrhosis. Operative mortality rates for immediate versus delayed DRS were 46.2 per cent and 17 per cent, respectively. HRS improved significantly in elective DSRS patients from 1.46 to 1.30. Predictors of HRS2 included HRS1 and time in days from the index bleed to operation. The most important predictor of early survival for all patients after elective DSRS was the HRS2; however, for patients who underwent elective DSRS and survived, HRS1 was a better predictor of length of survival than HRS2. No other variable analyzed accurately predicted survival. We conclude that HRS can be expected to improve with supportive in hospital therapy; improved HRS at the time of operation is associated with decreased operative mortality; and the extent of liver disease as determined by HRS1 appears to be the chief determinant of long-term patient survival.

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