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ECONOMICS, EDUCATION, AND HEALTH SYSTEMS RESEARCH

The Impact of Hepatitis C Status on Postoperative Outcome

Ramsey C. Cheung, MD^*,, Frank Hsieh, PhD, Yajie Wang, MS, and John B. Pollard, MD^,

*Division of Gastroenterology and Hepatology, Cooperative Studies Program Coordinating Center, and Department of Anesthesia, VA Palo Alto Health Care System; and Stanford University, California

Address correspondence to Ramsey Cheung, MD, VA Palo Alto HCS (154C), 3801 Miranda Ave., Palo Alto, CA 94304. Address e-mail to rcheung{at}stanford.edu

The impact of the hepatitis C virus (HCV) infection on the postoperative complication rate is unknown. We identified a population of surgical patients (n = 2457) for whom the HCV antibody (anti-HCV) had been measured and compared after surgical complications and mortality between those who were positive (17.9%) versus negative. The complication rates were 10% in the anti-HCV positive and 13% in the negative group (P = 0.125), whereas the mortality rates were 0.7% and 2.5%, respectively (P = 0.017). The anti-HCV positive patients were younger, had lower ASA physical status, and underwent shorter procedures. In the univariate analysis, emergent surgery and high ASA physical status but not anti-HCV positivity were associated with a more frequent complication. In the multivariate analysis, the urgency of surgery, age, ASA physical status, length of surgery, and preoperative hematocrit (but not platelet count) were associated with complications. Anti-HCV positivity was associated with an odds ratio for having a complication of 1.08 (95% confidence interval, 0.90–1.30), which was not statistically significant (P = 0.405). In conclusion, we were unable to show HCV antibody status to be an independent risk factor for postoperative complications when other co-factors were considered.

IMPLICATIONS: In this large study at a Veterans Administration medical center, the urgency of surgery, age, ASA physical status, length of surgery, and preoperative hematocrit were all independently associated with postoperative complications. However, hepatitis C infection was not an independent risk factor for postoperative complications.