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[Multimorbidity in liver surgery]
Emrullah Birgin1, Jan Heil2, Elisabeth Miller2
1Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland. emrullah.birgin@uniklinik-ulm.de.
Insights
Multimorbid patients face higher risks after liver resection, especially with open procedures and certain liver conditions. Minimally invasive surgery and enhanced recovery protocols can significantly improve outcomes.
Area of Science:
- Hepatobiliary surgery
- Geriatric medicine
- Chronic disease management
Context:
- Multimorbidity, defined as 3+ chronic diseases, affects over 50% of patients over 60.
- The Charlson Comorbidity Index (CCI) assesses multimorbidity severity and its impact on surgical outcomes.
- Liver resection patients often present with complex comorbidities.
Purpose:
- To evaluate the impact of multimorbidity on postoperative outcomes following liver resection.
- To identify specific risk factors and protective strategies for multimorbid patients undergoing liver surgery.
Summary:
- Multimorbid patients have increased morbidity and mortality risks post-liver resection, primarily due to liver failure.
- Open liver resection with biliary reconstruction, especially for primary liver tumors associated with metabolic associated fatty liver disease (MAFLD), poses a significant risk.
- Minimally invasive resection, liver preconditioning, and enhanced recovery after surgery (ERAS) protocols demonstrably reduce postoperative complications.
Impact:
- Highlights the elevated risks associated with multimorbidity in liver surgery.
- Emphasizes the benefits of minimally invasive approaches and standardized perioperative care.
- Informs surgical decision-making and patient management strategies for complex liver resection cases.
Abstract:
Multimorbidity is characterized by the presence of at least 3 chronic diseases with a prevalence of more than 50% of patients over 60 years old. The Charlson comorbidity index (CCI) enables a description of the severity of the multimorbidity and also provides a correlation with the postoperative outcome after liver resection. According to this, multimorbid patients are at increased risk of morbidity and mortality after liver resection, mostly due to postoperative liver failure. In particular, open major liver resection with biliary reconstruction and primary liver tumors linked to metabolic associated fatty liver disease (MAFLD) pose an increased risk for multimorbid patients. In contrast, minimally invasive resection leads to a clear reduction in postoperative morbidity and mortality. Preconditioning of the liver and the implementation of perioperative strategies according to the enhanced recovery after surgery (ERAS) concept can also lead to an improvement of the postoperative outcome.
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