{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T06:51:45Z","timestamp":1784357505017,"version":"3.55.0"},"reference-count":26,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2023,10,20]],"date-time":"2023-10-20T00:00:00Z","timestamp":1697760000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,4,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Those with cirrhosis who require emergency colorectal surgery are at risk for poor outcomes. Although risk predictions models exists, these tools are not specific to colorectal surgery, nor were they developed in a contemporary setting. Thus, the objective of this study was to assess the outcomes in this population and determine whether cirrhosis etiology and\/or the Model for End Stage Liver Disease (MELD-Na) is associated with mortality.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This population-based study included those with cirrhosis undergoing emergent colorectal surgery between 2009 and 2017. All eligible individuals in Ontario were identified using administrative databases. The primary outcome was 90-day mortality.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Nine hundred and twenty-seven individuals (57%) (male) were included. The most common cirrhosis etiology was non-alcoholic fatty liver disease (NAFLD) (50%) and alcohol related (32%). Overall 90-day mortality was 32%. Multivariable survival analysis demonstrated those with alcohol-related disease were at increased risk of 90-day mortality (hazards ratio [HR] 1.53, 95% confidence interval [CI] 1.2\u20132.0 vs. NAFLD [ref]). Surgery for colorectal cancer was associated with better survival (HR 0.27, 95%CI 0.16\u20130.47). In the subgroup analysis of those with an available MELD-Na score (n = 348\/927, 38%), there was a strong association between increasing MELD-Na and mortality (score 20+ HR 6.6, 95%CI 3.9\u201310.9; score 10\u201319 HR 1.8, 95%CI 1.1\u20133.0; score &amp;lt;10 [ref]).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Individuals with cirrhosis who require emergent colorectal surgery have a high risk of postoperative complications, including mortality. Increasing MELD-Na score is associated with mortality and can be used to risk stratify individuals.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jcag\/gwad040","type":"journal-article","created":{"date-parts":[[2023,10,20]],"date-time":"2023-10-20T19:02:32Z","timestamp":1697828552000},"page":"160-168","source":"Crossref","is-referenced-by-count":4,"title":["Emergency Colorectal Surgery in Those with Cirrhosis: A Population-based Study Assessing Practice Patterns, Outcomes and Predictors of Mortality"],"prefix":"10.1093","volume":"7","author":[{"given":"Lisa","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Surgery, University of Ottawa , Ottawa, ON , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly","family":"Brennan","sequence":"additional","affiliation":[{"name":"Department of Surgery, Queen\u2019s University , Kingston, ON , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer A","family":"Flemming","sequence":"additional","affiliation":[{"name":"Department of Surgery, Queen\u2019s University , Kingston, ON , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sulaiman","family":"Nanji","sequence":"additional","affiliation":[{"name":"Department of Surgery, Queen\u2019s University , Kingston, ON , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maya","family":"Djerboua","sequence":"additional","affiliation":[{"name":"Department of Surgery, Queen\u2019s University , Kingston, ON , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaila J","family":"Merchant","sequence":"additional","affiliation":[{"name":"Department of Surgery, Queen\u2019s University , Kingston, ON , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Caycedo-Marulanda","sequence":"additional","affiliation":[{"name":"Orlando Health , Orlando, FL , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunil V","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Surgery, Queen\u2019s University , Kingston, ON , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,10,20]]},"reference":[{"issue":"1","key":"2024050310285988100_CIT0001","first-page":"1","article-title":"\u201cSurgery and Portal Hypertension.\u201d","volume":"1","author":"Child","year":"1964","journal-title":"Major Problems in Clinical Surgery"},{"key":"2024050310285988100_CIT0002","first-page":"646","article-title":"\u201cTransection of the Oesophagus for Bleeding Oesophageal Varices","volume-title":"The British Journal of Surgery","author":"Pugh","year":"1973"},{"key":"2024050310285988100_CIT0003","first-page":"864","article-title":"\u201cA Model to Predict Poor Survival in Patients Undergoing Transjugular Intrahepatic Portosystemic Shunts.\u201d","volume-title":"Hepatology","author":"Malinchoc","year":"2000"},{"key":"2024050310285988100_CIT0004","first-page":"204","article-title":"\u201cRisk Prediction Models for Post-Operative Mortality in Patients With Cirrhosis.\u201d","volume-title":"Hepatology (Baltimore, Md.)","author":"Mahmud","year":"2021"},{"key":"2024050310285988100_CIT0005","first-page":"1261","article-title":"\u201cRisk Factors for Mortality After Surgery in Patients with Cirrhosis.\u201d","volume-title":"Gastroenterology","author":"Teh","year":"2007"},{"key":"2024050310285988100_CIT0006","first-page":"1832","article-title":"\u201cCoexisting Liver Disease Is Associated with Increased Mortality After Surgery for Diverticular Disease.\u201d","volume-title":"Digestive Diseases and Sciences","author":"Montomoli","year":"2015"},{"key":"2024050310285988100_CIT0007","first-page":"1367","article-title":"\u201cThe Impact of Cirrhosis and Portal Hypertension on Mortality Following Colorectal Surgery: A Nationwide, Population-Based Study.\u201d","volume-title":"Diseases of the Colon and Rectum","author":"Nguyen","year":"2009"},{"key":"2024050310285988100_CIT0008","first-page":"529","article-title":"\u201cThe Surgical Risk of Colectomy in Patients with Cirrhosis.\u201d","volume-title":"Diseases of the Colon and Rectum","author":"Metcalf","year":"1987"},{"key":"2024050310285988100_CIT0009","first-page":"1511","article-title":"\u201cShould We Use the Model for End-Stage Liver Disease (MELD) to Predict Mortality After Colorectal Surgery?.\u201d","volume-title":"Journal of Gastrointestinal Surgery","author":"Pantel","year":"2016"},{"key":"2024050310285988100_CIT0010","first-page":"210","article-title":"\u201cThe Outcome of Colorectal Surgery in Cirrhotic Patients: A Case Match Report.\u201d","volume-title":"Chirurgia","author":"Lacatus","year":"2018"},{"key":"2024050310285988100_CIT0011","first-page":"1","article-title":"\u201cLiver Cirrhosis\/Severe Fibrosis Is a Risk Factor for Anastomotic Leakage after Colorectal Surgery.\u201d","volume-title":"Gastroenterology Research and Practice","author":"K\u00e4ser","year":"2016"},{"key":"2024050310285988100_CIT0012","first-page":"1045","article-title":"\u201cAcute Colonic Diverticulitis and Cirrhosis: Outcomes of Laparoscopic Colectomy Compared with an Open Approach.\u201d","volume-title":"Journal of the American College of Surgeons","author":"Kazi","year":"2020"},{"key":"2024050310285988100_CIT0013","first-page":"345","article-title":"\u201cAdverse Outcomes in Patients with Chronic Liver Disease Undergoing Colorectal Surgery.\u201d","volume-title":"Annals of Surgery","author":"Ghaferi","year":"2010"},{"key":"2024050310285988100_CIT0014","first-page":"1225","article-title":"\u201cColorectal Surgery in Cirrhotic Patients: Assessment of Operative Morbidity and Mortality.\u201d","volume-title":"Diseases of the Colon and Rectum","author":"Meunier","year":"2008"},{"key":"2024050310285988100_CIT0015","first-page":"e0201120","article-title":"\u201cIdentifying Cirrhosis, Decompensated Cirrhosis and Hepatocellular Carcinoma in Health Administrative Data: A Validation Study.\u201d","volume-title":"PLoS One","author":"Lapointe-Shaw","year":"2018"},{"key":"2024050310285988100_CIT0016","first-page":"183","article-title":"\u201cIdentifying Patients With Physician-Diagnosed Asthma in Health Administrative Databases.\u201d","volume-title":"Canadian Respiratory Journal","author":"Gershon","year":"2009"},{"key":"2024050310285988100_CIT0017","first-page":"316","article-title":"\u201cIdentifying Diabetes Cases from Administrative Data: A Population-Based Validation Study.\u201d","volume-title":"BMC Health Services Research","author":"Lipscombe","year":"2018"},{"key":"2024050310285988100_CIT0018","first-page":"160","article-title":"\u201cIdentifying Cases of Congestive Heart Failure From Administrative Data: A Validation Study Using Primary Care Patient Records.\u201d","volume-title":"Chronic Diseases and Injuries in Canada","author":"Schultz","year":"2013"},{"key":"2024050310285988100_CIT0019","first-page":"e18","article-title":"\u201cAccuracy of Administrative Databases in Identifying Patients With Hypertension.\u201d","volume-title":"Open Medicine.","author":"Tu","year":"2007"},{"key":"2024050310285988100_CIT0020","first-page":"806","article-title":"\u201cStrengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for Reporting Observational Studies.\u201d","volume-title":"BMJ","author":"von Elm","year":"2007"},{"key":"2024050310285988100_CIT0021","first-page":"e1001885","article-title":"\u201cThe Reporting of Studies Conducted Using Observational Routinely-Collected Health Data (RECORD) Statement.\u201d","volume-title":"PLoS Medicine","author":"Benchimol","year":"2015"},{"key":"2024050310285988100_CIT0022","first-page":"551","article-title":"\u201cWhen the Entire Population is the Sample: Strengths and Limitations in Register-Based Epidemiology.\u201d","volume-title":"European Journal of Epidemiology","author":"Thygesen","year":"2014"},{"key":"2024050310285988100_CIT0023","first-page":"648","article-title":"\u201cClarification of Risk Factors for Abdominal Operations in Patients with Hepatic Cirrhosis.\u201d","volume-title":"Annals of Surgery","author":"Garrison","year":"1984"},{"key":"2024050310285988100_CIT0024","first-page":"650","article-title":"\u201cThe Safety of Intra-Abdominal Surgery in Patients With Cirrhosis: Model for End-Stage Liver Disease Score is Superior to Child-Turcotte-Pugh Classification in Predicting Outcome.\u201d","volume-title":"Archives of Surgery (Chicago, Ill. : 1960)","author":"Befeler","year":"2005"},{"key":"2024050310285988100_CIT0025","first-page":"1315","article-title":"\u201cRecent Evidence on Alcohol and Cancer Epidemiology.\u201d","volume-title":"Future Oncology","author":"Scoccianti","year":"2013"},{"key":"2024050310285988100_CIT0026","first-page":"1174","article-title":"\u201cExtrahepatic Complications of Nonalcoholic Fatty Liver Disease.\u201d","volume-title":"Hepatology","author":"Armstrong","year":"2014"}],"container-title":["Journal of the Canadian Association of 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