The American College of Gastroenterology (ACG) has published a clinical guideline that presents a comprehensive approach to perioperative risk assessment and management in patients with cirrhosis – a population that it says presents “unique surgical risks.”
The guideline emphasizes a multidisciplinary approach to preoperative evaluation, perioperative care, and postoperative follow-up.
“Surgical decision-making in patients with cirrhosis requires a nuanced, multidisciplinary approach that accounts for the severity of liver disease, the presence of portal hypertension, nonhepatic comorbidities, and the nature and setting of the planned procedure,” writes ACG. “In this guideline, we have provided evidence-based recommendations and key concepts to support individualized preoperative risk assessment and perioperative optimization. Use of validated cirrhosis-surgical risk scores; attention to modifiable risk factors such as frailty, nutrition, and hemostatic derangements; and consideration of procedural alternatives or referral to high-volume centers are central to improving outcomes. Through thoughtful integration of these principles into clinical practice, providers can enhance surgical safety and inform shared decision-making for this growing and vulnerable patient population.”
Read the full guideline here.
Gastroenterology & Endoscopy News has published a Q&A with the guideline’s lead author, Nadim Mahmud, MD, MPH, transplant hepatologist and assistant professor of medicine and epidemiology at the University of Pennsylvania.
