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Guidance document: risk assessment of patients with cirrhosis prior to elective non-hepatic surgery
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...
Autores principales: | , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10423609/ https://www.ncbi.nlm.nih.gov/pubmed/37581186 http://dx.doi.org/10.1136/flgastro-2023-102381 |
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author | Abbas, Nadir Fallowfield, Jonathan Patch, David Stanley, Adrian J Mookerjee, Raj Tsochatzis, Emmanouil Leithead, Joanna A Hayes, Peter Chauhan, Abhishek Sharma, Vikram Rajoriya, Neil Bach, Simon Faulkner, Thomas Tripathi, Dhiraj |
author_facet | Abbas, Nadir Fallowfield, Jonathan Patch, David Stanley, Adrian J Mookerjee, Raj Tsochatzis, Emmanouil Leithead, Joanna A Hayes, Peter Chauhan, Abhishek Sharma, Vikram Rajoriya, Neil Bach, Simon Faulkner, Thomas Tripathi, Dhiraj |
author_sort | Abbas, Nadir |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-10423609 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-104236092023-08-14 Guidance document: risk assessment of patients with cirrhosis prior to elective non-hepatic surgery Abbas, Nadir Fallowfield, Jonathan Patch, David Stanley, Adrian J Mookerjee, Raj Tsochatzis, Emmanouil Leithead, Joanna A Hayes, Peter Chauhan, Abhishek Sharma, Vikram Rajoriya, Neil Bach, Simon Faulkner, Thomas Tripathi, Dhiraj Frontline Gastroenterol Guideline 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. BMJ Publishing Group 2023-03-08 /pmc/articles/PMC10423609/ /pubmed/37581186 http://dx.doi.org/10.1136/flgastro-2023-102381 Text en © 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. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) . |
spellingShingle | Guideline Abbas, Nadir Fallowfield, Jonathan Patch, David Stanley, Adrian J Mookerjee, Raj Tsochatzis, Emmanouil Leithead, Joanna A Hayes, Peter Chauhan, Abhishek Sharma, Vikram Rajoriya, Neil Bach, Simon Faulkner, Thomas Tripathi, Dhiraj Guidance document: risk assessment of patients with cirrhosis prior to elective non-hepatic surgery |
title | Guidance document: risk assessment of patients with cirrhosis prior to elective non-hepatic surgery |
title_full | Guidance document: risk assessment of patients with cirrhosis prior to elective non-hepatic surgery |
title_fullStr | Guidance document: risk assessment of patients with cirrhosis prior to elective non-hepatic surgery |
title_full_unstemmed | Guidance document: risk assessment of patients with cirrhosis prior to elective non-hepatic surgery |
title_short | Guidance document: risk assessment of patients with cirrhosis prior to elective non-hepatic surgery |
title_sort | guidance document: risk assessment of patients with cirrhosis prior to elective non-hepatic surgery |
topic | Guideline |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10423609/ https://www.ncbi.nlm.nih.gov/pubmed/37581186 http://dx.doi.org/10.1136/flgastro-2023-102381 |
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