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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...

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Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2023
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.
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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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