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©2007 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Aug 14, 2007; 13(30): 4056-4063
Published online Aug 14, 2007. doi: 10.3748/wjg.v13.i30.4056
Published online Aug 14, 2007. doi: 10.3748/wjg.v13.i30.4056
Outcomes of patients with cirrhosis undergoing non-hepatic surgery: Risk assessment and management
Farida Millwala, Geoffrey C Nguyen, Paul J Thuluvath, Hepatology Section, The Johns Hopkins University School of Medicine, Baltimore, MD 2105, United States
Author contributions: All authors contributed equally to the work.
Correspondence to: Paul J Thuluvath, MD, FRCP, Chief, Hepatology Section, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, United States. pjthuluv@jhmi.edu
Telephone: +1-410-6143589 Fax: +1-410-6149612
Received: April 10, 2007
Revised: April 21, 2007
Accepted: May 12, 2007
Published online: August 14, 2007
Revised: April 21, 2007
Accepted: May 12, 2007
Published online: August 14, 2007
Abstract
The reported mortality rates in patients with cirrhosis undergoing various non-transplant surgical procedures range from 8.3% to 25%. This wide range of mortality rates is related to severity of liver disease, type of surgery, demographics of patient population, expertise of the surgical, anesthesia and intensive care unit team and finally, reporting bias. In this article, we will review the pathophysiology, morbidity and mortality associated with non-hepatic surgery in patients with cirrhosis, and then recommend an algorithm for risk assessment and evidence based management strategy to optimize post-surgical outcomes.
Keywords: Pre-operative risk assessment, Risk stratification, Cirrhosis, Model for end-stage liver disease, Non-transplant surgery, Outcomes