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Evaluation and Management of Cirrhotic Patients Undergoing Elective Surgery

  • Liver (S Cotler and E Kallwitz, Section Editors)
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Abstract

Purpose of Review

Cirrhotic patients have an increased risk of surgical complications and higher perioperative morbidity and mortality based on the severity of their liver disease. Liver disease predisposes patients to perioperative coagulopathies, volume overload, and encephalopathy. The goal of this paper is to discuss the surgical risk of cirrhotic patients undergoing elective surgeries and to discuss perioperative optimization strategies.

Recent Findings

Literature thus far varies by surgery type and the magnitude of surgical risk. CTP and MELD classification scores allow for the assessment of surgical risk in cirrhotic patients.

Summary

Once the decision has been made to undergo elective surgery, cirrhotic patients can be optimized pre-procedure with the help of a checklist and by the involvement of a multidisciplinary team. Elective surgeries should be performed at hospital centers staffed by healthcare providers experienced in caring for cirrhotic patients. Further research is needed to develop ways to prepare this complicated patient population before elective surgery.

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Authors and Affiliations

  1. Department of Medicine, Mount Sinai Medical Center, New York, NY, USA

    Kelly E. Diaz

  2. Department of Medicine, Division of Liver Diseases, Recanati/Miller Transplantation Institute, Mount Sinai Medical Center, New York, NY, USA

    Thomas D. Schiano

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Diaz, K.E., Schiano, T.D. Evaluation and Management of Cirrhotic Patients Undergoing Elective Surgery. Curr Gastroenterol Rep 21, 32 (2019). https://doi.org/10.1007/s11894-019-0700-y

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