Clinical Guideline on Perioperative Management of Patients with Advanced Chronic Liver Disease

Abstract

(1) Background: Patients with advanced chronic liver disease (ACLD) are living longer with more comorbidities because of improved medical and surgical management. However, patients with ACLD are at increased risk of perioperative morbidity and mortality; (2) Methods: We conducted a comprehensive review of the literature to support a narrative clinical guideline about the assessment of mortality risk and management of perioperative morbidity in patients with ACLD undergoing surgical procedures; (3) Results: Slight data exist to guide the perioperative management of patients with ACLD, and most recommendations are based on case series and expert opinion. The severity of liver dysfunction, portal hypertension, cardiopulmonary and renal comorbidities, and complexity of surgery and type (elective versus emergent) are predictors of perioperative morbidity and mortality. Expert multidisciplinary teams are necessary to evaluate and manage ACLD before, during, and after surgical procedures; (4) Conclusions: This clinical practice document updates the available data and recommendations to optimize the management of patients with advanced chronic liver disease who undergo surgical procedures.

Factors Affecting Nurses’ Attitude Regarding Care of Patients with Liver Transplantation

“…Table (10): Showed that, there was no significant relation between studied nurses' attitude about liver transplantation and demographic characteristics p>0.05.…”

“…Liver transplantation is usually the best treatment for liver failure in patients who are fit enough for the operation and offers life-saving therapy for patients with complications of cirrhosis, this procedure has become a routine treatment with excellent outcomes for the great majority of recipients, and the outcomes of LT have improved significantly in recent years, due to improvements in surgical techniques, anesthesia, and immunosuppressive therapies (10) .…”

“…The preparation of the patient is fundamental in the perioperative period and the role of nurses is important for success of treatment, moreover the nurse is responsible for the planning and implementation of care delivered during the LT process so this study is carried for evaluating factors affecting nurses' performance regarding care of patients with liver transplantation (10) .…”

“…Convenience sample of 50 bedside nurses who are giving direct care for patients in liver transplant unit and have more than one year of experience, (30) working in previous settings and (10) nurses working in ICU that participate in care of patients, (10) nurses working in liver transplant operating room.…”

Comparison of Surgical Risk Scores in a European Cohort of Patients with Advanced Chronic Liver Disease

“…The postoperative mortality of patients with cirrhosis is an important area of improvement for professionals who participate in the care of these patients, especially considering that the need for surgical interventions has increased with age and comorbidity. This has motivated recent clinical guidelines on perioperative management of patients with ACLD [ 24 , 25 , 26 ].…”