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Review
. 2023 Mar 30;7(4):e0086.
doi: 10.1097/HC9.0000000000000086. eCollection 2023 Apr 1.

Assessing the risk of surgery in patients with cirrhosis

Melissa G Kaltenbach  1 , Nadim Mahmud  1   2   3   4
Affiliations
Review

Assessing the risk of surgery in patients with cirrhosis

Melissa G Kaltenbach et al. Hepatol Commun. .

Abstract

Patients with cirrhosis have an increased perioperative risk relative to patients without cirrhosis. This is related to numerous cirrhosis-specific factors, including severity of liver disease, impaired synthetic function, sarcopenia and malnutrition, and portal hypertension, among others. Nonhepatic comorbidities and surgery-related factors further modify the surgical risk, adding to the complexity of the preoperative assessment. In this review, we discuss the pathophysiological contributors to surgical risk in cirrhosis, key elements of the preoperative risk assessment, and application of risk prediction tools including the Child-Turcotte-Pugh score, Model for End-Stage Liver Disease-Sodium, Mayo Risk Score, and the VOCAL-Penn Score. We also detail the limitations of current approaches to risk assessment and highlight areas for future research.

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Conflict of interest statement

The authors have no conflicts to report.

Figures

FIGURE 1
FIGURE 1
Conceptual model for increased perioperative risk in patients with cirrhosis. Abbreviation: ASA, American Society of Anesthesiologists.
FIGURE 2
FIGURE 2
Association between surgery type (A) and ASA classification (B) and postoperative survival in patients with cirrhosis. Abbreviation: ASA, American Society of Anesthesiologists. Adapted from Mahmud et al with permission.
FIGURE 3
FIGURE 3
Declining calibration of the Mayo Risk Score over time for 90-day postoperative mortality. With each successive 3-year period since the publication of the Mayo Risk Score, the model has experienced degrading calibration such that the risk score progressively overestimates the true risk of postoperative mortality. This may be related to improvements in surgical technique, perioperative management, and the advent of more minimally invasive surgical techniques over time. Adapted from Mahmud et al, with permission.
See this image and copyright information in PMC

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