Guidance document: risk assessment of patients with cirrhosis prior to elective non-hepatic surgery.

Autor:	Abbas N; The Liver Unit, Queen Elizabeth Hospital, Birmingham, UK.; Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK., Fallowfield J; Centre for Inflammation Research, The University of Edinburgh The Queen's Medical Research Institute, Edinburgh, UK., Patch D; Hepatology and Liver Transplantation, Royal Free Hampstead NHS Trust, London, UK., Stanley AJ; Gastroenterology Department, Glasgow Royal Infirmary, Glasgow, UK., Mookerjee R; Institute for Liver and Digestive Health, University College London, London, UK., Tsochatzis E; Institute for Liver and Digestive Health, University College London, London, UK., Leithead JA; Department of Gastroenterology, Forth Valley Royal Hospital, Larbert, UK.; Hepatology, Forth Valley Royal Hospital, Larbert, UK., Hayes P; The Liver Unit, Royal Infirmary of Edinburgh, Edinburgh, UK., Chauhan A; The Liver Unit, Queen Elizabeth Hospital, Birmingham, UK.; Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK., Sharma V; GI and Liver Unit, Royal London Hospital, London, UK., Rajoriya N; The Liver Unit, Queen Elizabeth Hospital, Birmingham, UK.; Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK., Bach S; Academic Department of Surgery, University Hospitals NHS Foundation Trust, Birmingham, UK., Faulkner T; Department of Anaesthetics, University Hospitals NHS Foundation Trust, Birmingham, UK., Tripathi D; Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.; The Liver Unit, University Hospitals NHS Foundation Trust, Birmingham, UK.
Jazyk:	angličtina
Zdroj:	Frontline gastroenterology [Frontline Gastroenterol] 2023 Mar 08; Vol. 14 (5), pp. 359-370. Date of Electronic Publication: 2023 Mar 08 (Print Publication: 2023).
DOI:	10.1136/flgastro-2023-102381
Abstrakt:	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. Competing Interests: Competing interests: None declared. (© 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.)
Databáze:	MEDLINE
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