Evaluation of surgical risk in patients with liver cirrhosis

Česká verzia

Authors: Eva Uchytilová; Eva Kieslichová
Authors place of work: Klinika anesteziologie, resuscitace a intenzivní péče, Transplantcentrum IKEM Praha
Published in the journal: Vnitř Lék 2020; 66(4): 253-257
Category:

Summary

The prevalence of liver cirrhosis in population is increasing, as well as its prevalence among patients admitted to hospital for elective surgery. These patients are at risk of high postoperative morbidity and mortality. Perioperative risk assessment of patients with liver cirrhosis is a complex procedure. It consists of evaluation of general condition of the patient, including comorbidities and nutritional status, evaluation of the grade of liver disease, and urgency of the surgical procedure. There are no specific guidelines. Proper risk assessment before surgery, considering alternative ways of treatment, is a cornerstone of optimal postoperative course and prevention of complications in patients with liver cirrhosis.

Keywords:

liver cirrhosis – Child‑Pugh score – MELD score – perioperative risk

Zdroje

1. Asrani SK, Devarbhavi H, Eaton J, et al. Burden of liver diseases in the world. J Hepatol 2019; 70: 151–171.

2. Pimpin L, Cortez‑Pinto H, Negro F, et al. Burden of liver disease in Europe: Epidemiology and analysis of risk factors to identify prevention policies. J Hepatol 2018; 69: 718–735.

3. Ehrman J, Aiglová K, Konečný M, et al. Aktuální možnosti léčby jaterní cirhózy v ambulanci internisty. Vnitř Lék 2016; 62: 553–563.

4. Lata J, Vaňásek T, Stibůrek O. Jaterní cirhóza a její léčba. Vnitř Lék 2009; 55: 774–778.

5. Blachier M, Leleu H, Peck‑Radosavljevic M, et al. The burden of liver disease in Europe: a review of available epidemiological data. J Hepatol 2013; 58: 593–608.

6. International Surgical Outcomes Study group. Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high‑income countries. Br J Anaesth 2016; 117: 601–609.

7. Diaz KE, Schiano TD. Evaluation and Management of Cirrhotic Patients Undergoing Elective Surgery. Current Gastroenterology Reports 2019; 21: 32.

8. Im GY, Lubezky N, Facciuto ME et al. Surgery in patients with portal hypertension: a preoperative checklist and strategies for attenuating risk. Clin Liver Dis 2014; 18: 477–505.

9. Lin CS, Lin SY, Chang CC, et al. Postoperative adverse outcomes after non‑hepatic surgery in patients with liver cirrhosis. Br J Surg 2013; 100: 1784–1790.

10. Deleuran T, Vilstrup H, Overgaard S, et al. Cirrhosis patients have increased risk of complications after hip or knee arthroplasty. Acta Orthop 2015; 86: 108–113.

11. Nyberg EM, Batech M, Cheetham TC, et al. Postoperative Risk of Hepatic Decompensation after Orthopedic Surgery in Patients with Cirrhosis. J Clin Transl Hepatol 2016; 4: 83–89.

12. Garrison RN, Cryer HM, Howard DA, et al. Clarification of risk factors for abdominal operations in patients with hepatic cirrhosis. Ann Surg 1984; 199: 648–655.

13. Mansour A, Watson W, Shayani V, et al. Abdominal operations in patients with cirrho‑ sis: still a major surgical challenge. Surgery 1997; 122: 730–735.

14. Telem DA, Schiano T, Goldstone R, et al. Factors that predict outcome of abdominal operations in patients with advanced cirrhosis. Clin Gastroenterol Hepatol 2010; 8: 451–457.

15. Farnsworth N, Fagan SP, Berger DH, et al. Child‑Turcotte‑Pugh versus MELD score as a predictor of outcome after elective and emergent surgery in cirrhotic patients. Am J Surg 2004; 188: 580–583.

16. Teh SH, Nagorney DM, Stevens SR, et al. Risk factors for mortality after surgery in patients with cirrhosis. Gastroenterology 2007; 132: 1261–1269.

17. Biggins SW, Kim WR, Terrault NA, et al. Evidence‑based incorporation of serum sodium concentration into MELD. Gastroenterology 2006; 130: 1652–1660.

18. Ginès P, Guevara M Hyponatremia in cirrhosis: pathogenesis, clinical significance, and management. Hepatology 2008; 48: 1002–1010.

19. Costa BP, Sousa FC, Serôdio M, et al. Value of MELD and MELD‑based indices in surgical risk evaluation of cirrhotic patients: retrospective analysis of 190 cases. World J Surg 2009; 33: 1711–1719.

20. Kim DH, Kim SH, Kim KS, et al. Predictors of mortality in cirrhotic patients undergoing extrahepatic surgery: comparison of Child‑Turcotte‑Pugh and model for end‑stage liver disease‑based indices. ANZ J Surg 2014; 84: 832–836.

21. Causey MW, Steele SR, Farris Z, et al. An assessment of different scoring systems in cirrhotic patients undergoing nontransplant surgery. Am J Surg 2012; 203: 589–593.

22. Sato M, Tateishi R, Yasunaga H, et al. The ADOPT‑LC score: a novel predictive index of in‑hospital mortality of cirrhotic patients following surgical procedures, based on a national survey. Hepatol Res 2017; 47: E35–E43.

23. Henderson JM. What are the risks of general surgical abdominal operations in patients with cirrhosis? Clin Gastroenterol Hepatol 2010; 8: 399–400.