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Preoperative evaluation of patients with liver disease

Nature Clinical Practice Gastroenterology & Hepatology volume 4, pages 266–276 (2007)Cite this article

An Erratum to this article was published on 01 July 2007

Abstract

Patients with end-stage liver disease often undergo surgery for indications other than liver transplantation. These patients have an increased risk of morbidity and mortality that is related to their underlying liver disease. Assessments of surgical risk provide a basis for discussion of risks and benefits, treatment decision making, and for optimal management of patients for whom surgery is planned. The most useful indicators of surgical risk are indices that predict advanced disease, such as the Child–Turcotte–Pugh score, or those that predict prognosis, such as the Model for End-stage Liver Disease score. Careful preoperative risk assessment, patient selection, and management of various manifestations of advanced disease might decrease morbidity and mortality from nontransplant surgery in patients with liver disease.

Key Points

  • Elective surgery should be avoided in patients with acute liver diseases such as acute viral hepatitis or alcoholic hepatitis, if there is evidence of ongoing hepatic injury

  • For patients with chronic liver diseases, determine the severity of underlying disease and assess whether or not cirrhosis might be present before deciding whether to proceed with surgery

  • The Model for End-Stage Liver Disease and Child–Turcotte–Pugh scores can be used to stratify the risks of surgery for patients with chronic liver disease

  • Optimal preoperative management of the manifestations of advanced liver disease can reduce the risk of postoperative morbidity and mortality

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Figure 1: C-statistics for the use of the CTP or MELD score in prediction of 30-day postoperative mortality, or amortality and morbidity, in patients with cirrhosis
Figure 2: Proposed algorithm for the preoperative assessment of patients with liver disease

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Authors and Affiliations

  1. AJ Hanje is an Instructor in the Division of Gastroenterology, Hepatology and Nutrition at The Ohio State University. T Patel is Professor of Medicine at The Ohio State University and Director of Hepatology at The Ohio State University Medical Center, Columbus, OH, USA.,

    A James Hanje & Tushar Patel

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Correspondence to Tushar Patel.

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Hanje, A., Patel, T. Preoperative evaluation of patients with liver disease. Nat Rev Gastroenterol Hepatol 4, 266–276 (2007). https://doi.org/10.1038/ncpgasthep0794

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