ACG Clinical Guideline: Perioperative Risk Assessment and Management in Patients With Cirrhosis

Area of Science:

• Hepatology
• Surgical Oncology
• Anesthesiology

Background:

• Patients with cirrhosis face unique and elevated surgical risks.
• A systematic approach is needed for perioperative care in this population.
• Existing guidelines may not fully address the complexities of surgical risk in cirrhosis.

Purpose of the Study:

• To provide a comprehensive guideline for perioperative risk assessment and management in patients with cirrhosis.
• To outline strategies for preoperative optimization, intraoperative care, and postoperative follow-up.
• To promote evidence-based decision-making for surgical interventions in cirrhotic patients.

Main Methods:

• Multidisciplinary team approach integrating hepatologists, surgeons, and anesthesiologists.
• Utilizing validated cirrhosis-specific risk calculators (e.g., VOCAL-Penn Score) for stratification.
• Review of evidence on preoperative optimization, surgical interventions, and center-specific expertise.

Main Results:

• Individualized risk assessment is crucial, considering liver disease severity, comorbidities, and surgery type.
• Preoperative optimization includes nutritional support, portal hypertension management, and addressing frailty.
• Interventions like TIPS and careful patient selection can mitigate risks for specific procedures.

Conclusions:

• A structured, multidisciplinary approach improves surgical outcomes in patients with cirrhosis.
• Objective risk assessment and shared decision-making are paramount.
• Guidelines should inform practice for managing this growing surgical population.