Risk and predictors of postoperative mortality in patients with liver cirrhosis undergoing trauma laparotomy: A systematic review and meta-analysis with meta-regression.

Abstract

Aims: To evaluate the effect of liver cirrhosis on postoperative mortality after trauma laparotomies.

Methods: A PRISMA-compliant meta-analysis with meta-regression using random-effects modelling was conducted (last search: 25 August 2025). All studies comparing the risk of postoperative mortality in adult patients with and without liver cirrhosis undergoing trauma laparotomies were included. The certainty of evidence was evaluated using GRADE system.

Results: Eight studies comprising 3,285 patients were included (cirrhosis group: 733; no cirrhosis group: 2,552). Both groups were comparable in terms of age (MD: 1.27 years, 95% CI -0.25, 2.79, p = 0.100), male sex (RD: 0.02, 95% CI -0.02, 0.06, p = 0.380), injury severity score (MD: 3.52, 95% CI -3.69, 10.73, p = 0.340), penetrating mechanism of injury (RD: -0.10, 95% CI -0.29, 0.09, p = 0.320), and blunt mechanism of injury (RD: 0.10, 95%CI -0.09, 0.29, p = 0.320). The risk of postoperative mortality was higher in patients with cirrhosis (OR: 3.68, 95% CI 2.76, 4.91, p < 0.00001). Age (coefficient: 0.015, p = 0.016) and blunt mechanism of injury (coefficient: 0.237, p = 0.047) increased the risk of postoperative mortality; penetrating mechanism of injury (coefficient: - 0.272, p = 0.042) was associated with reduced risk of mortality; male sex (coefficient: -0.424, p = 0.139) and injury severity score (coefficient: 0.004, p = 0.358) did not affect the mortality.

Conclusions: Liver cirrhosis may increase the risk of postoperative mortality in patients undergoing trauma laparotomies (moderate certainty). The decision to perform a trauma laparotomy in a patient with cirrhosis should ideally be guided by a multidisciplinary discussion to carefully weigh the potential risks against the expected benefits.