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The Safety of Intra-abdominal Surgery in Patients With Cirrhosis—Invited Critique

The Safety of Intra-abdominal Surgery in Patients With Cirrhosis—Invited Critique Invited Critique n prior times, the surgeon on rounds would stand at the bedside and observe a lemon-yellow patient awaiting an urgent I abdominal operation and proclaim, “He’s gonna die.” Although this judgment was wholly subjective, it was rarely in- correct. Subsequently, systems such as the Child and CTP classifications appeared, but these also suffered from subjectivity. The problem with all such predictors of death was that they did exactly that but provided the surgeon with little guidance in the way of therapeutic interventions by which to thwart the anticipated outcome. The present authors contend that the newer MELD classification is more predictive of patient outcome than the CTP classification, accurately predicting the demise of 9 of their 53 patients. However, when broken down by procedure, it was seen that 8 (33%) of 24 in the laparotomy group died, all of whom required urgent operation, whereas only 1 (3.4%) of 29 patients undergoing open or laparoscopic cholecystectomy died, verifying multiple previous studies showing emergency lapa- rotomies to be associated with extraordinary risk in the patient with cirrhosis. So this is not news. However, the authors also present the intriguing finding that a preoperative hemoglobin level of less than 10 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA Surgery American Medical Association

The Safety of Intra-abdominal Surgery in Patients With Cirrhosis—Invited Critique

JAMA Surgery , Volume 140 (7) – Jul 1, 2005

The Safety of Intra-abdominal Surgery in Patients With Cirrhosis—Invited Critique

Abstract

Invited Critique n prior times, the surgeon on rounds would stand at the bedside and observe a lemon-yellow patient awaiting an urgent I abdominal operation and proclaim, “He’s gonna die.” Although this judgment was wholly subjective, it was rarely in- correct. Subsequently, systems such as the Child and CTP classifications appeared, but these also suffered from subjectivity. The problem with all such predictors of death was that they did exactly that but provided the...
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Publisher
American Medical Association
Copyright
Copyright 2005 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.
ISSN
2168-6254
eISSN
2168-6262
DOI
10.1001/archsurg.140.7.655
Publisher site
See Article on Publisher Site

Abstract

Invited Critique n prior times, the surgeon on rounds would stand at the bedside and observe a lemon-yellow patient awaiting an urgent I abdominal operation and proclaim, “He’s gonna die.” Although this judgment was wholly subjective, it was rarely in- correct. Subsequently, systems such as the Child and CTP classifications appeared, but these also suffered from subjectivity. The problem with all such predictors of death was that they did exactly that but provided the surgeon with little guidance in the way of therapeutic interventions by which to thwart the anticipated outcome. The present authors contend that the newer MELD classification is more predictive of patient outcome than the CTP classification, accurately predicting the demise of 9 of their 53 patients. However, when broken down by procedure, it was seen that 8 (33%) of 24 in the laparotomy group died, all of whom required urgent operation, whereas only 1 (3.4%) of 29 patients undergoing open or laparoscopic cholecystectomy died, verifying multiple previous studies showing emergency lapa- rotomies to be associated with extraordinary risk in the patient with cirrhosis. So this is not news. However, the authors also present the intriguing finding that a preoperative hemoglobin level of less than 10

Journal

JAMA SurgeryAmerican Medical Association

Published: Jul 1, 2005

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