ReviewClinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association2020
Perioperative Evaluation and Management of Patients With Cirrhosis: Risk Assessment, Surgical Outcomes, and Future Directions.
Review in Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04615091 ("Prognostic Role of Portal Hypertension Assessed by Non-invasive Methods to Stratify Surgical Risk in Compensated Advanced Chronic Liver Disease Patients Undergoing Elective Extrahepatic Surgery), which is not on this map. Cited by 42 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
"Prognostic Role of Portal Hypertension Assessed by Non-invasive Methods to Stratify Surgical Risk in Compensated Advanced Chronic Liver Disease Patients Undergoing Elective Extrahepatic Surgery: ELASTOSURGERY STUDY."
Who cites it
42 citing papers in PubMed, 3 syntheses or guidelines pooled it, 94 citations in OpenAlex.
- Impact of liver cirrhosis on postoperative outcomes following total hip and knee arthroplasty : a systematic review and meta-analysis.Bone & joint open · 2025Pooled it
- Esophagectomy in patients with liver cirrhosis: systematic review and meta-analysis of short-term outcomes.Updates in surgery · 2025Pooled it
- A systematic review of preoperative transjugular intrahepatic portosystemic shunt prior to extrahepatic, abdominal surgery in patients with cirrhosis.Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association · 2024Pooled it
- High-Risk Comorbidities Drive Adverse Inpatient Outcomes After ERCP: A National Analysis and Predictive Model.Digestive diseases and sciences · 2026Article
- Long-term prognosis and postoperative liver atrophy after gastrectomy in patients with gastric cancer and liver cirrhosis.Surgery today · 2026Article
- Post-colonoscopy gallbladder hemorrhage in decompensated cirrhosis: an unusual complication.Journal of surgical case reports · 2026Article
- Hemostasis in Liver Disease Within Patient Blood Management: A Scoping Review of the Current Literature.Journal of clinical medicine · 2026Review
- Hepatogenous diabetes in the era of precision medicine: diagnosis, management, and future directions.Clinical and experimental medicine · 2026Review
- MELD score is predictive of postoperative morbidity and mortality in patients with acute appendicitis undergoing appendectomy: ACS-NSQIP data analysis.Surgical endoscopy · 2026Article
- Fibrosis-4 Score and Postoperative Outcomes in Metabolic Dysfunction-Associated Steatotic Liver Disease.The Turkish journal of gastroenterology : the official journal of Turkish Society of Gastroenterology · 2026Article
- Impact of Child-Pugh score on surgical outcomes after distal gastrectomy and right hemicolectomy: a retrospective study from the Japanese National Clinical Database.International journal of surgery (London, England) · 2026Article
- Aortic stenosis in cirrhosis: Pathophysiology and management in the context of liver transplantation.World journal of transplantation · 2025Review
- Liver Disease Predicts 30-Day Postoperative Complications in Head and Neck Microvascular Surgery.The Laryngoscope · 2025Article
- Effects of Protocol-driven Care by Internists on Adherence to Clinical Practice Guidelines for Hip Fracture Surgery Patients: An Interrupted Time Series Study Using a Nationwide Inpatient Database.Internal medicine (Tokyo, Japan) · 2025Article
- Clinical Ascites and Emergency Procedure as Determinants of Surgical Risk in Patients with Advanced Chronic Liver Disease.Journal of clinical medicine · 2025Article
- Association of ALBI Grade, APRI Score, and ALBI-APRI Score with Postoperative Outcomes among Patients with Liver Cirrhosis after Non-hepatic Surgery.Acta medica Philippina · 2025Article
- Article
- Recent TIPS increases postoperative mortality: A national cohort study.Hepatology communications · 2024Article
- Prognosis of Cirrhotic Patients After Osteoporotic Femoral Neck Fracture.Journal of clinical medicine · 2024Article
- Perioperative Risk in Patients With Cirrhosis.Gastroenterology & hepatology · 2024Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors at 3 institutions in 1 country.
Funding
Abstract
BACKGROUND AND
aimsPatients with cirrhosis are at increased risk of perioperative morbidity and mortality. We provide a narrative review of the available data regarding perioperative morbidity and mortality, risk assessment, and management of patients with cirrhosis undergoing non-hepatic surgical procedures.
methodsWe conducted a comprehensive review of the literature from 1998-2018 and identified 87 studies reporting perioperative outcomes in patients with cirrhosis. We extracted elements of study design and perioperative mortality by surgical procedure, Child-Turcotte-Pugh (CTP) class and Model for End-stage Liver Disease (MELD) score reported in these 87 studies to support our narrative review.
resultsOverall, perioperative mortality is 2-10 times higher in patients with cirrhosis compared to patients without cirrhosis, depending on the severity of liver dysfunction. For elective procedures, patients with compensated cirrhosis (CTP class A, or MELD <10) have minimal increase in operative mortality. CTP class C patients (or MELD >15) are at high risk for mortality; liver transplantation or alternatives to surgery should be considered. Very little data exist to guide perioperative management of patients with cirrhosis, so most recommendations are based on case series and expert opinion. Existing risk calculators are inadequate.
conclusionsSeverity of liver dysfunction, medical comorbidities and the type and complexity of surgery, including whether it is elective versus emergent, are all determinants of perioperative mortality and morbidity in patients with cirrhosis. There are major limitations to the existing clinical research on risk assessment and perioperative management that warrant further investigation.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.