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Coexisting Liver Disease Is Associated with Increased Mortality After Surgery for Diverticular Disease

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Abstract

Background

Coexistence of liver disease in patients undergoing surgery for diverticular disease (DD) may increase the risk of postoperative complications, but the evidence is limited.

Aim

To investigate the impact of liver disease on mortality and reoperation rates following surgery for DD.

Methods

We performed a cohort study based on medical databases of all patients undergoing surgery for DD in Denmark during 1977–2011, categorizing them into three cohorts according to history of liver disease: patients with non-cirrhotic liver disease, those with liver cirrhosis, and those without liver disease (comparison cohort). Using the Kaplan–Meier method, we computed mortality in each cohort for 0–30, 31–60, and 61–90 days following surgery for DD. We used a Cox regression model to compute hazard ratios as measures of the relative risk (RR) of death, controlling for potential confounders, including other comorbidities. In addition, we assessed the reoperation rate within 30 days of initial surgery.

Results

Of 14,408 patients undergoing surgery for DD, 233 (1.6 %) had non-cirrhotic liver disease and 91 (0.6 %) had liver cirrhosis. Thirty-day mortality was 9.9 % in patients without liver disease and 14.6 % in patients with non-cirrhotic liver disease [adjusted RR = 1.64 (95 % confidence interval [CI] 1.16–2.31)]. Among patients with liver cirrhosis, mortality was 24.2 % [adjusted RR = 2.70 (95 % CI 1.73–4.22)]. Liver cirrhosis had an impact on mortality up to 60 days after surgery for DD. The reoperation rate was approximately 10 % in each cohort.

Conclusion

Preexisting liver disease has a major impact on postoperative mortality following surgery for DD.

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Abbreviations

CCI:

Charlson comorbidity index

CI:

Confidence interval

CPR number:

Civil personal registration number

CRS:

Civil Registration System

DD:

Diverticular disease

DNRP:

Danish National Registry of Patients

ICD:

International Classification of Diseases

NOMESCO:

Nordic Medico-Statistical Committee

RR:

Relative risk

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Acknowledgments

The study received financial support from the Department of Clinical Epidemiology’s Research Foundation, Aarhus University Hospital, Denmark. The first author is an Aarhus University scholarship recipient.

Conflict of interest

None.

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Authors and Affiliations

  1. Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Århus N, Denmark

    Jonathan Montomoli, Rune Erichsen, Lars Pedersen, Tove Nilsson & Henrik Toft Sørensen

  2. Division of Gastroenterology, Department of Medicine, Harborview Medical Center, University of Washington Medical School, 325 Ninth Avenue, Seattle, WA, 98104, USA

    Lisa L. Strate

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  1. Jonathan Montomoli
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  2. Rune Erichsen
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  3. Lisa L. Strate
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  4. Lars Pedersen
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Correspondence to Jonathan Montomoli.

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Montomoli, J., Erichsen, R., Strate, L.L. et al. Coexisting Liver Disease Is Associated with Increased Mortality After Surgery for Diverticular Disease. Dig Dis Sci 60, 1832–1840 (2015). https://doi.org/10.1007/s10620-014-3503-x

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  • DOI: https://doi.org/10.1007/s10620-014-3503-x

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