66ecb7ee01f40f57246432c9f92a84bd pmc_9860873.pdf f768f585a620f18e5520c020084c0012408386b1 pmc_9860873.pdf 67b046a82f5d5baab2fbc3a09ae4fdaa2804205003ca1fe17baf5dc4bc4b473c pmc_9860873.pdf Title: Clinical Guideline on Perioperative Management of Patients with Advanced Chronic Liver Disease Subject: (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. Keywords: hepatic; surgery; mortality; risk Author: Lidia Canillas, Amalia Pelegrina, Juan Álvarez, Elena Colominas-González, Antonio Salar, Lluís Aguilera, Fernando Burdio, Antonio Montes, Santiago Grau, Luis Grande and José A. Carrión Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Sun Jan 8 11:43:30 2023 CET ModDate: Sun Jan 8 11:46:38 2023 CET Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 26 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 1877530 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- OHKNFJ+VnURWPalladioL Type 1 Custom yes yes no 10 0 FOYQRW+URWPalladioL-Bold Type 1 Custom yes yes no 15 0 YQAIUD+URWPalladioL-Roma Type 1 Custom yes yes no 20 0 RXWVEY+URWPalladioL-Ital Type 1 Custom yes yes no 24 0 FFAYKL+VnURWPalladioL-Bold Type 1 Custom yes yes no 28 0 PJCGLK+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 47 0 ZZLTBA+CMSY10 Type 1 Builtin yes yes no 75 0 CAMXTK+EURM10 Type 1 Builtin yes yes no 79 0 ABCDEE+Palatino Linotype,Bold TrueType WinAnsi yes yes no 91 0 ABCDEE+Palatino Linotype TrueType WinAnsi yes yes no 95 0 ABCDEE+Palatino Linotype,Italic TrueType WinAnsi yes yes no 99 0 ABCDEE+Palatino Linotype CID TrueType Identity-H yes yes yes 103 0 ABCDEE+Palatino Linotype,Bold TrueType WinAnsi yes yes no 120 0 ABCDEE+Palatino Linotype TrueType WinAnsi yes yes no 124 0 ABCDEE+Palatino Linotype,Italic TrueType WinAnsi yes yes no 128 0 ABCDEE+Palatino Linotype CID TrueType Identity-H yes yes yes 132 0 Arial TrueType WinAnsi no no no 139 0 ABCDEE+Palatino Linotype,Bold TrueType WinAnsi yes yes no 157 0 ABCDEE+Palatino Linotype TrueType WinAnsi yes yes no 161 0 ABCDEE+Palatino Linotype,Italic TrueType WinAnsi yes yes no 165 0 Arial TrueType WinAnsi no no no 169 0 ABCDEE+Palatino Linotype,Bold TrueType WinAnsi yes yes no 202 0 ABCDEE+Palatino Linotype TrueType WinAnsi yes yes no 206 0 ABCDEE+Palatino Linotype,Italic TrueType WinAnsi yes yes no 210 0 ABCDEE+Palatino Linotype CID TrueType Identity-H yes yes yes 214 0 Jhove (Rel. 1.22.1, 2019-04-17) Date: 2023-08-15 02:25:43 CEST RepresentationInformation: pmc_9860873.pdf ReportingModule: PDF-hul, Rel. 1.12.1 (2019-04-17) LastModified: 2023-07-28 02:23:21 CEST Size: 1877530 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 695 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@44c8afef Item: Title: Materials and Methods Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@7b69c6ba Item: Title: Results Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@46daef40 Children: Item: Title: Section 1. Preoperative Evaluation and Management Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@12f41634 Children: Item: Title: Pathophysiology Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@13c27452 Item: Title: Diagnosis of Advanced Chronic Liver Disease Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@262b2c86 Item: Title: Surgical Risk Prediction Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@371a67ec Item: Title: Preoperative Management Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@5ed828d Item: Title: Assessment of Coagulation Disorders Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@50d0686 Item: Title: Section 2. Surgical Procedures Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@7a3d45bd Children: Item: Title: General Recommendations Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@1e7c7811 Item: Title: Elective Surgery Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@77ec78b9 Item: Title: Emergent Surgery Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@1a3869f4 Item: Title: Section 3. Intraoperative Management Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@a38d7a3 Children: Item: Title: Anaesthetic Technique Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@77f99a05 Item: Title: Loco-Regional Anaesthesia Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@63440df3 Item: Title: Cardiovascular Assessment and Intraoperative Monitoring Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@3aeaafa6 Item: Title: Fluids and Vasopressors during Surgery Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@76a3e297 Item: Title: Section 4. General Recomendations in Postoperative Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@4d3167f4 Children: Item: Title: Transfusion Strategy in Acute Bleeding after Surgery Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@ed9d034 Item: Title: Venous Thromboembolism Prophylaxis Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@6121c9d6 Item: Title: Pain Control Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@87f383f Item: Title: Nutrition Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@4eb7f003 Item: Title: Section 5. Postoperative Management of Hepatic Decompensation and ACLD Complications Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@eafc191 Children: Item: Title: Acute Kidney Injury Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@612fc6eb Item: Title: Encephalopathy Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@1060b431 Item: Title: Ascites Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@612679d6 Item: Title: Acute-on-Chronic Liver Failure Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@11758f2a Item: Title: Discussion Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@e720b71 Children: Item: Title: Limitations Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@1b26f7b2 Item: Title: Future Directions Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@491cc5c9 Item: Title: Conclusions Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@74ad1f1f Item: Title: References Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@6a1aab78 Info: Title: Clinical Guideline on Perioperative Management of Patients with Advanced Chronic Liver Disease Author: Lidia Canillas, Amalia Pelegrina, Juan Álvarez, Elena Colominas-González, Antonio Salar, Lluís Aguilera, Fernando Burdio, Antonio Montes, Santiago Grau, Luis Grande and José A. Carrión Subject: (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. 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