Perioperative management of patients with liver disease for non-hepatic surgery: A systematic review

Simegn, Atsedu Endale; Melesse, Debas Yaregal; Bizuneh, Yosef Belay; Alemu, Wudie Mekonnen

doi:10.1016/j.amsu.2022.103397

Cited by 10 publications

(11 citation statements)

References 27 publications

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“…These problems may cause significant morbidity & mortality. In studied cases with liver disease undergoing surgical procedures, evaluation can expect survival to some extent (1) . Number of studied cases with liver disease seeking surgical intervention is rising.…”

Section: Introductionmentioning

confidence: 99%

Risk Stratification in Cirrhotic Patients with Emergent Surgery

Ahmed¹,

Elfauomy²,

Elzohry³

et al. 2023

The Egyptian Journal of Hospital Medicine

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Background: Patients with liver disease have a unique pathophysiology that results in the need for a specialized evaluation before undergoing any surgical procedure. The objective of the present study was to assess different risk scores for highrisk cirrhotic patients. Patients and methods: We evaluated 115 cirrhotic patients in an Emergency Department, of the National Liver Institute, Menoufia University, using MELD, PALBI, ALBI, MELD Na scores. The studied cases had different presentations; 79 patients with strangulated umbilical hernia with bowel loops, 29 patients with intestinal ischemia from acute mesenteric vascular occlusion managed by surgical explorations, and 7 patients with secondary peritonitis from neglected spontaneous bacterial peritonitis. All participants signed an informed written consent.

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Section: Introductionmentioning

confidence: 99%

Risk Stratification in Cirrhotic Patients with Emergent Surgery

Ahmed¹,

Elfauomy²,

Elzohry³

et al. 2023

The Egyptian Journal of Hospital Medicine

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“…3 Despite advances in modern surgical and intensive care treatment, perioperative mortality remains high in patients with cirrhosis that undergo surgery. 4 Prognostic scoring systems for the underlying surgical disease in combination with the state of liver disease have therefore been investigated. 5 Scoring systems for cirrhosis, such as Child-Pugh classification and model for end-stage liver disease (MELD), have been correlated with outcome.…”

Section: Introductionmentioning

confidence: 99%

Severe cirrhosis is associated with increased surgical mortality and morbidities in patients with hip fractures: a propensity-score matched analysis using a large inpatient database

Hamada

Shin

Tsutsumi

et al. 2023

Preprint

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Objective: The aim of this study was to compare postoperative mortality and morbidities in patients with hip fractures undergoing surgery by Child-Pugh classes. Summary Background Data: Advanced cirrhosis is associated with increased mortality in several types of surgery, but the impact of severity of cirrhosis on postoperative outcomes in patients with hip fractures remain unclear. Methods: We analyzed data of patients with hip fracture within a large inpatient database. We performed three sets of 1:1 propensity-score matching for four groups: cases without cirrhosis, and Child-Pugh classes A, B and C. We compared in-hospital mortality, length of stay, hospitalization fee, rate of 30-day readmission and complications in the following three pairs: cases without cirrhosis vs Child-Pugh class A, Child-Pugh class A vs B, and Child-Pugh class B vs C. Results: Among 833,648 eligible cases, propensity-score matching created 1,065 pairs between cases without cirrhosis vs Child-Pugh class A, 1,012 pairs between Child-Pugh class A vs B, and 489 pairs between Child-Pugh class B vs C. In-hospital mortality did not differ between cases with cirrhosis and those with Child-Pugh A classification (1.69% vs 1.41%; RD -0.28%; 95% CI: -1.34%-0.78%). In-hospital mortality was significantly higher in patients with Child-Pugh B classification than in those with A classification (1.48% vs 5.93%; RD 4.45%; 95% CI: 2.79%-6.10%), and in those with Child-Pugh C classification compared with those with B classification (6.34% vs 28.43%; RD 22.09%; 95% CI: 17.54%-26.63%). Among cases with cirrhosis, those in more severe Child-Pugh classes had longer length of stay, higher hospitalization fees and higher ratio of complications, such as acute liver failure, upper gastrointestinal bleeding and sepsis. Conclusions: Our results could help to identify patients at high-risk of postoperative mortality and morbidity among those with both hip fracture and cirrhosis. Patients with Child-Pugh C classification may benefit from discussions about nonsurgical management, goals of care, and overall prognosis.

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“…[1][2][3] These patients are at an increased risk of peri-operative morbidity and mortality, as peri-operative mortality of 10%, 30% and 80% have been reported in chronic liver disease Child-Pugh class A, B and C, respectively. 4 Most of the perioperative mortality in liver disease patients is due to hepatocellular injury caused by hypotension, haemorrhage, sepsis, acute hepatitis, effects of hepatotoxic drugs, systemic vasoconstriction with hepatic insufficiency due to neuroendocrine stress response or decompensated liver failure. 5,6 Intraoperative haemorrhage in liver disease may be due to coagulation factors deficiency, thrombocytopenia, oesophagal or ectopic varices or portosystemic shunting.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Pre-Operative Blood Loss in Seropositive and Seronegative Pregnant Women Undergoing Elective Cesarean Section

Akbar

Zainab²,

Mahboob³

et al. 2023

PAFMJ

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Objective: To compare the intraoperative blood loss and adhesions, peri-operative blood and intravenous iron supplementation between hepatitis seropositive and seronegative pregnant women undergoing elective cesarean delivery. Study Design: Cross-sectional, analytical study. Place and Duration of Study: Departments of Anesthesiology and Gynecology & Obstetrics, Combine Military Hospital, Okara Cantt Pakistan, from Oct 2018 to Mar 2019. Methodology: After approval of the hospital ethical committee, 134 (n=67 in each Group) pregnant women were included in our study by convenient sampling. Patients were divided into two groups. Group-A included seronegative pregnant women, whereas Group-B were seropositive pregnant women. Results: There was no difference in the age (p=0.357), gravidity (p=0.159), parity (p=0.226) and the number of cesarean sections (p=0.475) between the two groups. There was no difference in the two groups regarding peri-operative haemoglobin change,with an insignificant reduction of 0.60±1.21 g/dL in Group-A versus a reduction of 0.50±1.08 g/dL in Group-B. A mild level of adhesion was observed intraoperatively in 26(35.6%) in Group-A versus 27(37.5%) in Group-B; p=0.170. Mild difficulty securing hemostasis was reported in 25(34.2%) vs 29(40.2%) patients; p=0.329. 61(83.5%) did not require a peri-operative blood transfusion in Group-A versus 59(81.9%) in Group-B; p=0.528. Conclusion: Our study has shown that the peri-operative haemoglobin level, blood product and intravenous iron supplementation, intra-operative adhesions encountered, and difficulty in hemostasis were comparable between sero-positive and sero-negative viral hepatitis pregnant women.

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Perioperative management of patients with liver disease for non-hepatic surgery: A systematic review

Cited by 10 publications

References 27 publications

Risk Stratification in Cirrhotic Patients with Emergent Surgery

Risk Stratification in Cirrhotic Patients with Emergent Surgery

Severe cirrhosis is associated with increased surgical mortality and morbidities in patients with hip fractures: a propensity-score matched analysis using a large inpatient database

Comparison of Pre-Operative Blood Loss in Seropositive and Seronegative Pregnant Women Undergoing Elective Cesarean Section

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