Guidance document: risk assessment of patients with cirrhosis prior to elective non-hepatic surgery.
ABDOMINAL SURGERY
CIRRHOSIS
PORTAL HYPERTENSION
Journal
Frontline gastroenterology
ISSN: 2041-4137
Titre abrégé: Frontline Gastroenterol
Pays: England
ID NLM: 101528589
Informations de publication
Date de publication:
2023
2023
Historique:
medline:
15
8
2023
pubmed:
15
8
2023
entrez:
15
8
2023
Statut:
epublish
Résumé
As a result of the increasing incidence of cirrhosis in the UK, more patients with chronic liver disease are being considered for elective non-hepatic surgery. A historical reluctance to offer surgery to such patients stems from general perceptions of poor postoperative outcomes. While this is true for those with decompensated cirrhosis, selected patients with compensated early-stage cirrhosis can have good outcomes after careful risk assessment. Well-recognised risks include those of general anaesthesia, bleeding, infections, impaired wound healing, acute kidney injury and cardiovascular compromise. Intra-abdominal or cardiothoracic surgery are particularly high-risk interventions. Clinical assessment supplemented by blood tests, imaging, liver stiffness measurement, endoscopy and assessment of portal pressure (derived from the hepatic venous pressure gradient) can facilitate risk stratification. Traditional prognostic scoring systems including the Child-Turcotte-Pugh and Model for End-stage Liver Disease are helpful but may overestimate surgical risk. Specific prognostic scores like Mayo Risk Score, VOCAL-Penn and ADOPT-LC can add precision to risk assessment. Measures to mitigate risk include careful management of varices, nutritional optimisation and where possible addressing any ongoing aetiological drivers such as alcohol consumption. The role of portal decompression such as transjugular intrahepatic portosystemic shunting can be considered in selected high-risk patients, but further prospective study of this approach is required. It is of paramount importance that patients are discussed in a multidisciplinary forum, and that patients are carefully counselled about potential risks and benefits.
Identifiants
pubmed: 37581186
doi: 10.1136/flgastro-2023-102381
pii: flgastro-2023-102381
pmc: PMC10423609
doi:
Types de publication
Journal Article
Langues
eng
Pagination
359-370Informations de copyright
© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
Références
Circ J. 2017 Mar 24;81(4):476-484
pubmed: 28163280
Best Pract Res Clin Gastroenterol. 2012 Feb;26(1):47-59
pubmed: 22482525
J Hepatol. 2018 Aug;69(2):406-460
pubmed: 29653741
J Gastrointest Surg. 2011 Jan;15(1):1-11
pubmed: 21061184
Eur J Gastroenterol Hepatol. 2021 Dec 1;33(1S Suppl 1):e254-e259
pubmed: 33323758
Gastroenterology. 2013 Jun;144(7):1426-37, 1437.e1-9
pubmed: 23474284
J Bone Joint Surg Br. 2003 Aug;85(6):818-21
pubmed: 12931797
J Am Coll Surg. 2003 Jun;196(6):874-9
pubmed: 12788423
Int J Surg. 2014;12(8):810-4
pubmed: 25008280
Clin Gastroenterol Hepatol. 2019 Mar;17(4):595-606
pubmed: 30273751
Am J Surg. 2015 Jun;209(6):1020-7
pubmed: 25457249
Liver Transpl. 2003 Jun;9(6):623-5
pubmed: 12783406
World J Surg Oncol. 2021 Jun 9;19(1):167
pubmed: 34107967
Hepatol Res. 2017 Mar;47(3):E35-E43
pubmed: 27062144
Surg Laparosc Endosc Percutan Tech. 2001 Jun;11(3):189-94
pubmed: 11444750
J Gastrointest Surg. 2008 Apr;12(4):675-81
pubmed: 18270782
J Am Coll Surg. 2012 Aug;215(2):255-61
pubmed: 22640532
Hepatology. 2020 Jan;71(1):334-345
pubmed: 31342529
J Hepatol. 2020 Oct;73(4):842-854
pubmed: 32673741
Ann Surg Oncol. 2017 Mar;24(3):763-769
pubmed: 27704371
Int J Colorectal Dis. 2022 Mar;37(3):607-616
pubmed: 34894289
Surgery. 2011 Sep;150(3):542-6
pubmed: 21621237
Dis Colon Rectum. 2008 Aug;51(8):1225-31
pubmed: 18521677
J Gastrointest Surg. 2019 Dec;23(12):2383-2390
pubmed: 30820792
Gastroenterology. 2007 Apr;132(4):1261-9
pubmed: 17408652
J Vasc Surg. 2011 Apr;53(4):906-11
pubmed: 21215574
J Hepatol. 2019 Jan;70(1):172-193
pubmed: 30144956
Am J Surg. 2020 Oct;220(4):865-872
pubmed: 32107011
Am J Cardiol. 2017 Aug 15;120(4):648-654
pubmed: 28693742
Ann Thorac Surg. 2004 Feb;77(2):500-5
pubmed: 14759426
Hernia. 2018 Jun;22(3):419-426
pubmed: 29071496
Lancet Gastroenterol Hepatol. 2020 Mar;5(3):245-266
pubmed: 31981519
Am J Surg. 2008 Sep;196(3):373-8
pubmed: 18639226
Am J Surg. 2004 Nov;188(5):580-3
pubmed: 15546574
World J Surg. 2011 Jun;35(6):1229-33; discussion 1234
pubmed: 21365342
World J Gastroenterol. 2007 Aug 14;13(30):4056-63
pubmed: 17696222
Hernia. 2009 Oct;13(5):461-8
pubmed: 19652907
Gut. 2015 Nov;64(11):1680-704
pubmed: 25887380
Dis Colon Rectum. 1987 Jul;30(7):529-31
pubmed: 3595374
World J Surg. 2022 Mar;46(3):531-541
pubmed: 34988603
Dis Colon Rectum. 2009 Aug;52(8):1367-74
pubmed: 19617746
J Trauma Acute Care Surg. 2013 Feb;74(2):611-6
pubmed: 23354259
World J Surg. 2003 Jun;27(6):647-52
pubmed: 12732995
Ann Surg. 2005 Aug;242(2):244-51
pubmed: 16041215
Surg Laparosc Endosc Percutan Tech. 2006 Oct;16(5):330-3
pubmed: 17057574
Surgery. 2007 Sep;142(3):372-5
pubmed: 17723889
Hepatology. 2021 Jan;73(1):204-218
pubmed: 32939786
Br J Surg. 2013 Jan;100(2):209-16
pubmed: 23034741
J Arthroplasty. 2021 Jan;36(1):148-153.e1
pubmed: 32739079
HPB (Oxford). 2011 Mar;13(3):192-7
pubmed: 21309937
Ann Surg. 1993 Apr;217(4):338-46
pubmed: 8466308
Expert Rev Gastroenterol Hepatol. 2021 Oct;15(10):1191-1200
pubmed: 33706616
World J Emerg Surg. 2018 Jul 18;13:32
pubmed: 30034510
J Am Coll Surg. 2009 Jan;208(1):96-103
pubmed: 19228510
Int J Colorectal Dis. 2017 Apr;32(4):521-530
pubmed: 27987016
Eur J Gastroenterol Hepatol. 2018 Jan;30(1):21-26
pubmed: 29049129
Eur J Cardiothorac Surg. 2020 Oct 25;:
pubmed: 33099615
Gut. 2005 Apr;54(4):556-63
pubmed: 15753544
BMJ Open. 2018 Jul 17;8(7):e020511
pubmed: 30018094
Clin Gastroenterol Hepatol. 2004 Aug;2(8):719-23
pubmed: 15290666
Gastroenterology. 2019 Jul;157(1):34-43.e1
pubmed: 30986390
NIH Consens Statement. 1992 Sep 14-16;10(3):1-28
pubmed: 1301217
Langenbecks Arch Surg. 2021 Feb;406(1):219-225
pubmed: 33237442
Ann Med Surg (Lond). 2019 Nov 22;49:9-13
pubmed: 31853365
Surg Today. 1997;27(1):17-21
pubmed: 9035295
Surg Obes Relat Dis. 2021 Mar;17(3):525-537
pubmed: 33339694
J Hepatol. 2018 Mar;68(3):563-576
pubmed: 29111320
J Hepatol. 2019 Nov;71(5):942-950
pubmed: 31330170
HPB (Oxford). 2018 Feb;20(2):101-109
pubmed: 29110990
J Korean Med Sci. 2007 Apr;22(2):223-6
pubmed: 17449928
JHEP Rep. 2022 Jan 21;4(3):100442
pubmed: 35198929
World J Gastroenterol. 2005 Aug 14;11(30):4623-7
pubmed: 16094699
Obes Surg. 2020 Mar;30(3):941-947
pubmed: 31863408
J Cardiothorac Surg. 2017 Sep 2;12(1):73
pubmed: 28865456
Int J Surg. 2009 Feb;7(1):66-9
pubmed: 19028148
Gut. 2020 Jul;69(7):1173-1192
pubmed: 32114503
Anesthesiology. 1999 Jan;90(1):42-53
pubmed: 9915311
Int J Cardiol. 2016 Jan 15;203:682-9
pubmed: 26583843
Clin Gastroenterol Hepatol. 2010 May;8(5):451-7, quiz e58
pubmed: 20036761
Hernia. 2005 Dec;9(4):353-7
pubmed: 16132187
Int J Clin Exp Med. 2015 Nov 15;8(11):20712-21
pubmed: 26884994
J Am Coll Surg. 2003 Dec;197(6):921-6
pubmed: 14644279
J Hepatol. 2021 Sep;75(3):589-599
pubmed: 33905794
J Hepatol. 2012 Oct;57(4):874-84
pubmed: 22634123
Lancet. 2022 Jan 1;399(10319):61-116
pubmed: 34863359
J Arthroplasty. 2005 Jun;20(4):460-6
pubmed: 16124961
Surg Endosc. 2005 Mar;19(3):418-23
pubmed: 15624057
Catheter Cardiovasc Interv. 2021 Dec 1;98(7):E1044-E1057
pubmed: 34562288
Ann Surg. 1984 Jun;199(6):648-55
pubmed: 6732310
BMJ. 2006 Sep 9;333(7567):530-4
pubmed: 16960208
Dig Dis Sci. 2015 Jun;60(6):1832-40
pubmed: 25559756
Eur J Cardiothorac Surg. 2010 Nov;38(5):592-9
pubmed: 20413316
SICOT J. 2019;5:40
pubmed: 31674904
Ann Surg. 2021 Oct 1;274(4):e345-e354
pubmed: 31714310
Interact Cardiovasc Thorac Surg. 2015 Apr;20(4):520-30
pubmed: 25612743
J Bone Joint Surg Am. 2004 Feb;86(2):335-41
pubmed: 14960679
Ann Surg. 2010 Aug;252(2):345-50
pubmed: 20622652
Hernia. 2022 Dec;26(6):1435-1445
pubmed: 35412192