Preoperative Evaluation and Management of Patients With Select Chronic Gastrointestinal, Liver, and Renal Diseases

Preoperative risk evaluation and optimization for patients with liver disease

“…If performed the day before surgery, it may improve ventilation and volume control, as well as decrease infection risk, especially spontaneous bacterial peritonitis. In addition, thoracentesis should only be performed in patients with moderate to large pleural effusions, including hepatic hydrothorax, that cause impaired pulmonary function [ 15 ]. Postoperatively, excess intravenous fluid and blood products may cause volume overload and increased portal pressures.…”

“…Prophylactic preoperative fresh frozen plasma (FFP) based on INR alone is not recommended and its additional volume may cause worsening portal hypertension and increasing risk of further complications [ 65 ]. In the setting of significant malnutrition or biliary obstruction, vitamin K may be utilized [ 15 ].…”

“…Patients with cirrhosis undergoing abdominal surgery are at increased risk of poor outcomes when they also have protein-calorie malnutrition or sarcopenia [ 15 ]. To diagnose malnutrition, patients must have at least one phenotypic criterion (weight loss, low body mass index, and reduced muscle mass) and one etiologic criterion (reduced food intake or assimilation, and inflammation or disease burden).…”

“…Renal impairment is a sequelae of portal hypertension, expressed by the incorporation of creatinine as a factor of the MELD score. Close monitoring of kidney function postoperatively is recommended [ 15 ].…”

“…If there is uncertainty about the diagnosis of cirrhosis when using non-invasive testing, liver biopsy is the gold standard and would be a useful next step prior to surgery. Until formal evaluation and optimization of liver disease has been accomplished, elective surgeries should be delayed [ 15 ].…”