Mortality Risk for a Patient with Child-Pugh Class B Cirrhosis Undergoing Elective Segmental Colon Resection
The risk of dying from an elective segmental colon resection in a patient with Child-Pugh class B cirrhosis (bilirubin 2.3, albumin 2.4, INR 1.8, no ascites or encephalopathy) is approximately 30%.
Assessment of Surgical Risk in Cirrhotic Patients
The Child-Pugh classification is a widely used tool to assess liver function and surgical risk in patients with cirrhosis. Based on the patient's laboratory values:
- Bilirubin 2.3 mg/dL (2-3 points)
- Albumin 2.4 g/dL (3 points)
- INR 1.8 (2-3 points)
- No ascites (1 point)
- No encephalopathy (1 point)
This patient has a Child-Pugh score of 8-10, placing them in Child-Pugh class B 1.
Mortality Risk Factors
Several factors contribute to the increased mortality risk in this patient:
- Child-Pugh class B cirrhosis significantly increases surgical mortality compared to Child-Pugh class A 1
- The presence of portal hypertension (suggested by elevated INR) further increases risk 1
- Elevated bilirubin and low albumin are independent predictors of poor surgical outcomes 1
Evidence on Mortality Rates
- For general colorectal surgery, the overall operative mortality rate is approximately 10% 1
- However, this rate increases substantially in patients with liver cirrhosis 1
- Studies show that patients with both portal hypertension and elevated bilirubin (as in this case) have a 5-year survival of less than 30%, regardless of Child-Pugh stage 1
- For patients with Child-Pugh class B cirrhosis undergoing elective surgery, mortality rates approach 30% 2
Risk Stratification by Child-Pugh Class
- Child-Pugh class A: Relatively low surgical mortality (5-10%) 1
- Child-Pugh class B: Significantly increased surgical mortality (approximately 30%) 2
- Child-Pugh class C: Extremely high surgical mortality (50-80%) 2
Additional Risk Considerations
- The presence of coagulopathy (INR 1.8) increases the risk of perioperative bleeding complications 3
- Hypoalbuminemia (albumin 2.4) impairs wound healing and increases the risk of infection 1
- The combination of elevated bilirubin and portal hypertension is particularly concerning for postoperative liver decompensation 1
Clinical Implications
- Elective procedures should generally be avoided in patients with Child-Pugh class B or C cirrhosis whenever possible 2
- If surgery is deemed necessary, careful preoperative optimization and close postoperative monitoring are essential 1
- The risk of postoperative liver decompensation (particularly ascites) is high in patients with portal hypertension 1
Based on the patient's clinical parameters and the available evidence, the mortality risk for this elective segmental colon resection is approximately 30% (answer C).