Improving survival in patients with cirrhosis undergoing major abdominal operations.

Fifty-one patients with cirrhosis underwent 65 major abdominal procedures, with an 8% mortality and a 28% complication rate. Preoperative and perioperative management was comparable to that rendered patients with cirrhosis undergoing portosystemic shunting procedures. Emergency operation, persistent coagulation defects (prothrombin time and partial thromboplastin time prolonged greater than 2 s), blood loss greater than 4 U, and exploration of the common bile duct were factors associated with increased mortality. Major surgical procedures can be safely performed in critically ill patients with cirrhosis with intensive preoperative care and with minimizing intraoperative blood loss.