Surgical risk assessment in patients with liver cirrosis

Abstract

Cirrhotic patients may require surgical procedures and face higher morbidity and mortality than the general population. Adverse results are associated with multiple factors, but the most important are the severity of the liver disease, the urgency of the procedure and the type of surgery. The Child-Turcott-Pugh score (CTP) and the MELD score can be used to determine the severity of liver disease and to stratify the risk. Patients with CTP A are considered to tolerate elective surgery well, and surgery is permissible in patients with CTP B or MELD <14 with good preoperative preparation. It is contraindicated in patients with CTP C or MELD> 15 with albumin <2.5 gr/dL. Ideally, elective, minimally invasive procedures are used in specialized centers with doctors trained in the care of this type of patient. Preoperative optimization after risk stratification and careful management are mandatory before and after surgery. A multidisciplinary, individualized and specialized approach can improve results.