{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T18:11:33Z","timestamp":1787163093068,"version":"build-2736575974"},"reference-count":42,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2020,10,22]],"date-time":"2020-10-22T00:00:00Z","timestamp":1603324800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Biology"],"abstract":"<jats:p>(1) Purpose: As it is known, patients with liver cirrhosis (LC) undergoing colon surgery or hernia surgery have high perioperative morbidity and mortality. However, data about patients with LC undergoing small bowel surgery is lacking. This study aimed to analyze the morbidity and mortality of patients with LC after small bowel surgery in order to determine predictive risk factors for a poor outcome. (2) Methods: A retrospective analysis was performed of all patients undergoing small bowel surgery between January 2002 and July 2018 and identified 76 patients with LC. Postoperative complications were analyzed using the classification of Dindo\/Clavien (D\/C) and further subdivided (hemorrhage, pulmonary complication, wound healing disturbances, renal failure). A total of 38 possible predictive factors underwent univariate and multivariate analyses for different postoperative complications and in-hospital mortality. (3) Results: Postoperative complications [D\/C grade \u2265 II] occurred in 90.8% of patients and severe complications (D\/C grade \u2265 IIIB) in 53.9% of patients. Nine patients (11.8%) died during the postoperative course. Predictive factors for overall complications were \u201cadditional surgery\u201d (OR 5.3) and \u201cbowel anastomosis\u201d (OR 5.6). For postoperative mortality, we identified the model of end-stage liver disease (MELD) score (OR 1.3) and portal hypertension (OR 5.8) as predictors. The most common complication was hemorrhage, followed by pulmonary complications, hydropic decompensation, renal failure, and wound healing disturbances. The most common risk factors for those complications were portal hypertension (PH), poor liver function, emergency or additional surgery, ascites, and high ASA score. (4) Conclusions: LC has a devastating influence on patients\u2019 outcomes after small bowel resection. PH, poor liver function, high ASA score, and additional or emergency surgery as well as ascites were significant risk factors for worse outcomes. Therefore, PH should be treated before surgery whenever possible. Expansion of the operation should be avoided whenever possible and in case of at least moderate preoperative ascites, the creation of an anastomotic ostomy should be evaluated to prevent leakages.<\/jats:p>","DOI":"10.3390\/biology9110349","type":"journal-article","created":{"date-parts":[[2020,10,22]],"date-time":"2020-10-22T10:27:58Z","timestamp":1603362478000},"page":"349","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Risk Factors for Postoperative Morbidity and Mortality after Small Bowel Surgery in Patients with Cirrhotic Liver Disease\u2014A Retrospective Analysis of 76 Cases in a Tertiary Center"],"prefix":"10.3390","volume":"9","author":[{"given":"Maximilian","family":"Wetterkamp","sequence":"first","affiliation":[{"name":"Department of Surgery, University Hospital of Bonn, 53127 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cornelius J.","family":"van Beekum","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Hospital of Bonn, 53127 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria A.","family":"Willis","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Hospital of Bonn, 53127 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6996-9766","authenticated-orcid":false,"given":"Tim R.","family":"Glowka","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Hospital of Bonn, 53127 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steffen","family":"Manekeller","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Hospital of Bonn, 53127 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rolf","family":"Fimmers","sequence":"additional","affiliation":[{"name":"Institute of Medical Biometrics, Informatics and Epidemiology, Study Center Bonn, University Hospital of Bonn, 53127 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7033-9956","authenticated-orcid":false,"given":"Michael","family":"Praktiknjo","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, University Hospital of Bonn, 53127 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, University Hospital of Bonn, 53127 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joerg C.","family":"Kalff","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Hospital of Bonn, 53127 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim O.","family":"Vilz","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Hospital of Bonn, 53127 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,10,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"263","DOI":"10.4254\/wjh.v6.i5.263","article-title":"Obesity and non-alcoholic fatty liver disease: Disparate associations among Asian populations","volume":"6","author":"Wong","year":"2014","journal-title":"World J. Hepatol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.cld.2013.09.019","article-title":"Obesity and liver disease: The epidemic of the twenty-first century","volume":"18","author":"Corey","year":"2014","journal-title":"Clin. Liver Dis."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"14185","DOI":"10.3748\/wjg.v20.i39.14185","article-title":"Nonalcoholic fatty liver disease and aging: Epidemiology to management","volume":"20","author":"Bertolotti","year":"2014","journal-title":"World J. Gastroenterol."},{"key":"ref_4","first-page":"192","article-title":"Surgery in the Patient with Liver Disease","volume":"121","author":"Friedman","year":"2010","journal-title":"Trans. Am. Clin. Clim. Assoc."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"4056","DOI":"10.3748\/wjg.v13.i30.4056","article-title":"Outcomes of patients with cirrhosis undergoing non-hepatic surgery: Risk assessment and management","volume":"13","author":"Millwala","year":"2007","journal-title":"World J. Gastroenterol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s11605-010-1366-9","article-title":"Perioperative mortality after non-hepatic general surgery in patients with liver cirrhosis: An analysis of 138 operations in the 2000s using Child and MELD scores","volume":"15","author":"Neeff","year":"2010","journal-title":"J. Gastrointest. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1002\/lt.25675","article-title":"The Development and Outcome of Acute-on-Chronic Liver Failure after Surgical Interventions","volume":"26","author":"Klein","year":"2019","journal-title":"Liver Transplant."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1007\/s00268-003-6794-1","article-title":"Risk factors for nonhepatic surgery in patients with cirrhosis","volume":"27","author":"Rodriguez","year":"2003","journal-title":"World J. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2657","DOI":"10.3748\/wjg.v22.i9.2657","article-title":"Outcomes of abdominal surgery in patients with liver cirrhosis","volume":"22","author":"Ballus","year":"2016","journal-title":"World J. Gastroenterol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1097\/00000542-199901000-00008","article-title":"Morbidity and mortality in cirrhotic patients undergoing anesthesia and surgery","volume":"90","author":"Ziser","year":"1999","journal-title":"Anesthesiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"730","DOI":"10.1016\/S0039-6060(97)90080-5","article-title":"Abdominal operations in patients with cirrhosis: Still a major surgical challenge","volume":"122","author":"Mansour","year":"1997","journal-title":"Surgery"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"874","DOI":"10.1016\/j.jhep.2012.03.037","article-title":"Assessment of risk for non-hepatic surgery in cirrhotic patients","volume":"57","author":"Bhangui","year":"2012","journal-title":"J. Hepatol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1001\/archsurg.1984.01390160072014","article-title":"Umbilical herniorrhaphy in cirrhotic patients","volume":"119","author":"Leonetti","year":"1984","journal-title":"Arch. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/0002-9610(82)90129-5","article-title":"Cholecystectomy in cirrhotic patients: A formidable operation","volume":"143","author":"Aranha","year":"1982","journal-title":"Am. J. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1367","DOI":"10.1007\/DCR.0b013e3181a80dca","article-title":"The impact of cirrhosis and portal hypertension on mortality following colorectal surgery: A nationwide, population-based study","volume":"52","author":"Nguyen","year":"2009","journal-title":"Dis. Colon Rectum"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1016\/S1542-3565(04)00296-4","article-title":"Predicting outcome after cardiac surgery in patients with cirrhosis: A comparison of Child-Pugh and MELD scores","volume":"2","author":"Suman","year":"2004","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1097\/01.sla.0000133083.54934.ae","article-title":"Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey","volume":"240","author":"Dindo","year":"2004","journal-title":"Ann. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1148\/radiology.143.1.7063747","article-title":"The meaning and use of the area under a receiver operating characteristic (ROC) curve","volume":"143","author":"McNeil","year":"1982","journal-title":"Radiology"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1097\/01.sla.0000171327.29262.e0","article-title":"Model for End-Stage Liver Disease (MELD) predicts nontransplant surgical mortality in patients with cirrhosis","volume":"242","author":"Northup","year":"2005","journal-title":"Ann. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"650","DOI":"10.1001\/archsurg.140.7.650","article-title":"The 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","volume":"140","author":"Befeler","year":"2005","journal-title":"Arch. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1261","DOI":"10.1053\/j.gastro.2007.01.040","article-title":"Risk factors for mortality after surgery in patients with cirrhosis","volume":"132","author":"Teh","year":"2007","journal-title":"Gastroenterology"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Han, E.C., Ryoo, S.-B., Park, J.W., Yi, J.W., Oh, H.-K., Choe, E.K., Ha, H.-K., Park, B.K., Moon, S.H., and Jeong, S.-Y. (2017). Oncologic and surgical outcomes in colorectal cancer patients with liver cirrhosis: A propensity-matched study. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0178920"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Lacatus, M., Costin, L., Bodean, V., Manuc, M., and Vasilescu, C. (2018). The Outcome of Colorectal Surgery in Cirrhotic Patients: A Case Match Report. Chirurgia, 113.","DOI":"10.21614\/chirurgia.113.2.210"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1097\/SLA.0b013e3181e982d6","article-title":"Adverse outcomes in patients with chronic liver disease undergoing colorectal surgery","volume":"252","author":"Ghaferi","year":"2010","journal-title":"Ann. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1225","DOI":"10.1007\/s10350-008-9336-y","article-title":"Colorectal surgery in cirrhotic patients: Assessment of operative morbidity and mortality","volume":"51","author":"Meunier","year":"2008","journal-title":"Dis. Colon Rectum"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1007\/s00384-016-2739-7","article-title":"Factors affecting the postoperative morbidity and survival of patients with liver cirrhosis following colorectal cancer surgery","volume":"32","author":"Lee","year":"2016","journal-title":"Int. J. Color. Dis."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1016\/j.ijsu.2018.05.730","article-title":"Safety of laparoscopic resection for colorectal cancer in patients with liver cirrhosis: A retrospective cohort study","volume":"55","author":"Zhou","year":"2018","journal-title":"Int. J. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"3898","DOI":"10.1007\/s00464-017-5420-5","article-title":"Safety of laparoscopic radical gastrectomy in gastric cancer patients with liver cirrhosis","volume":"31","author":"Kim","year":"2017","journal-title":"Surg. Endosc."},{"key":"ref_29","first-page":"532","article-title":"Thresholds for optimal fluid administration and weight gain after laparoscopic colorectal surgery","volume":"3","author":"Pache","year":"2019","journal-title":"BJS Open"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2708","DOI":"10.1007\/s00268-018-4699-2","article-title":"Respiratory Complications after Colorectal Surgery: Avoidable or Fate?","volume":"42","author":"Jurt","year":"2018","journal-title":"World J. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1097\/MEG.0000000000000837","article-title":"Home-based drainage of refractory ascites by a permanent-tunneled peritoneal catheter can safely replace large-volume paracentesis","volume":"29","author":"Solbach","year":"2017","journal-title":"Eur. J. Gastroenterol. Hepatol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1080\/00365521.2018.1436190","article-title":"Prognosis of patients with ascites after PleurX insertion: An observational study","volume":"53","author":"Riedel","year":"2018","journal-title":"Scand. J. Gastroenterol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1244","DOI":"10.1177\/000313481608201234","article-title":"Development and Validation of a Risk Calculator for Renal Complications after Colorectal Surgery Using the National Surgical Quality Improvement Program Participant Use Files","volume":"82","author":"Ramonell","year":"2016","journal-title":"Am. Surg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e00025","DOI":"10.14309\/ctg.0000000000000025","article-title":"Sarcopenia Is Associated With Development of Acute-on-Chronic Liver Failure in Decompensated Liver Cirrhosis Receiving Transjugular Intrahepatic Portosystemic Shunt","volume":"10","author":"Praktiknjo","year":"2019","journal-title":"Clin. Transl. Gastroenterol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1014","DOI":"10.1002\/hep.29602","article-title":"Fat-free muscle mass in magnetic resonance imaging predicts acute-on-chronic liver failure and survival in decompensated cirrhosis","volume":"67","author":"Praktiknjo","year":"2018","journal-title":"Hepatology"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.jss.2016.05.030","article-title":"Impact of malnutrition on gastrointestinal surgical patients","volume":"205","author":"Mosquera","year":"2016","journal-title":"J. Surg. Res."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1016\/j.clnu.2014.07.012","article-title":"Malnutrition risk predicts surgical outcomes in patients undergoing gastrointestinal operations: Results of a prospective study","volume":"34","author":"Ho","year":"2015","journal-title":"Clin. Nutr."},{"key":"ref_38","first-page":"509","article-title":"Surgical infection and malnutrition","volume":"30","author":"Culebras","year":"2014","journal-title":"Nutr. Hosp."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"2725","DOI":"10.3748\/wjg.v22.i9.2725","article-title":"Liver surgery in cirrhosis and portal hypertension","volume":"22","author":"Hackl","year":"2016","journal-title":"World J. Gastroenterol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1016\/j.jhep.2004.01.017","article-title":"Maintenance of hemodynamic response to treatment for portal hypertension and influence on complications of cirrhosis","volume":"40","author":"Villanueva","year":"2004","journal-title":"J. Hepatol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1016\/j.jviscsurg.2017.09.002","article-title":"Laparoscopic versus open colectomy for obstructing right colon cancer: A systematic review and meta-analysis","volume":"154","author":"Cirocchi","year":"2017","journal-title":"J. Visc. Surg."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"2819","DOI":"10.3748\/wjg.v25.i22.2819","article-title":"Mini-invasive vs open resection of colorectal cancer and liver metastases: A meta-analysis","volume":"25","author":"Ye","year":"2019","journal-title":"World J. Gastroenterol."}],"container-title":["Biology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-7737\/9\/11\/349\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T10:26:17Z","timestamp":1760178377000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-7737\/9\/11\/349"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,10,22]]},"references-count":42,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2020,11]]}},"alternative-id":["biology9110349"],"URL":"https:\/\/doi.org\/10.3390\/biology9110349","relation":{},"ISSN":["2079-7737"],"issn-type":[{"value":"2079-7737","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,10,22]]}}}