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High mortality rate in patients with advanced liver disease independent of exposure to general anesthesia.

Cheung RC, McAuley RJ, Pollard JB

Division of Gastroenterology and Hepatology, VA Palo Alto Health Care System, Palo Alto, CA 94304, USA.

STUDY OBJECTIVE: To evaluate the survival of patients with advanced liver disease to determine if known exposure to general anesthesia within a 5-year period has a measurable effect on mortality. DESIGN: Retrospective survival analysis of male veterans with advanced liver disease. SETTING: Tertiary referral VA Medical Center and university-affiliated teaching hospital. MEASUREMENTS: One hundred twenty-seven patients with a history of alcoholic cirrhosis and documented hepatitis C infection and stable platelet counts were identified and then divided into 3 groups. The 5-year survival rates in all 3 groups were compared using Kaplan-Meier survival curves. MAIN RESULTS: Ninety patients had marked thrombocytopenia (<100000/mm3). Their survival rates with and without known exposure to general anesthesia were compared with those of control subjects with alcoholic cirrhosis and hepatitis C infection but with platelet counts greater than 100000/mm3. The 5-year survival rate of 57% in the group that received general anesthesia was comparable to the 58% rate observed in the group without this exposure. Both groups' rates were statistically lower than the 5-year survival rate of 77% in the group with advanced liver disease but without thrombocytopenia. CONCLUSION: Comparably high mortality rates were observed in patients with advanced liver disease with or without exposure to general anesthesia. Higher survival rates were noted in patients with advanced liver disease who were not thrombocytopenic.

Published 17 May 2005 in J Clin Anesth, 17(3): 172-6.
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