Understanding health care utilization and mortality after emergency general surgery in patients with underlying liver disease

Abstract

Background: Mortality and complications are not well defined nationally for emergency general surgery (EGS) patients presenting with underlying all-cause liver disease (LD). Study design: We analyzed the 2012-2014 National Inpatient Sample for adults (aged 18 years) with a primary EGS diagnosis. Underlying LD included International Classification of Diseases, Ninth Revision, Clinical Modification codes for alcoholic and viral hepatitis, malignancy, congenital etiologies, and cirrhosis. The primary outcome was mortality; secondary outcomes included complications, operative intervention, and costs. Results: Of the 6.8 million EGS patients, 358 766 (5.3%) had underlying LD. 59.1% had cirrhosis, 6.7% had portal hypertension, and 13.7% had ascites. Compared with other EGS patients, EGS-LD patients had higher mean costs ($12 847 vs $10 234, P .001). EGS-LD patients were less likely to have surgery (26.1% vs 37.0%, P .001) but for those who did, mortality was higher (4.8% vs 1.8%, P .001). Risk factors for mortality included ascites (adjusted odds ratio [aOR] = 2.68, P .001), dialysis (aOR = 3.44, P .001), sepsis (aOR = 8.97, P .001), and respiratory failure requiring intubation (aOR = 10.40, P .001). Odds of death increased in both surgical (aOR = 4.93, P .001) and non-surgical EGS-LD patients (aOR = 2.56, P .001). Conclusions: Underlying all-cause LD among EGS patients is associated with increased in-hospital mortality, even in the absence of surgical intervention.