RT Journal Article SR Electronic T1 Guidance document: risk assessment of patients with cirrhosis prior to elective non-hepatic surgery JF Frontline Gastroenterology JO Frontline Gastroenterol FD BMJ Publishing Group Ltd SP 359 OP 370 DO 10.1136/flgastro-2023-102381 VO 14 IS 5 A1 Abbas, Nadir A1 Fallowfield, Jonathan A1 Patch, David A1 Stanley, Adrian J A1 Mookerjee, Raj A1 Tsochatzis, Emmanouil A1 Leithead, Joanna A A1 Hayes, Peter A1 Chauhan, Abhishek A1 Sharma, Vikram A1 Rajoriya, Neil A1 Bach, Simon A1 Faulkner, Thomas A1 Tripathi, Dhiraj YR 2023 UL http://fg.bmj.com/content/14/5/359.abstract AB As a result of the increasing incidence of cirrhosis in the UK, more patients with chronic liver disease are being considered for elective non-hepatic surgery. A historical reluctance to offer surgery to such patients stems from general perceptions of poor postoperative outcomes. While this is true for those with decompensated cirrhosis, selected patients with compensated early-stage cirrhosis can have good outcomes after careful risk assessment. Well-recognised risks include those of general anaesthesia, bleeding, infections, impaired wound healing, acute kidney injury and cardiovascular compromise. Intra-abdominal or cardiothoracic surgery are particularly high-risk interventions. Clinical assessment supplemented by blood tests, imaging, liver stiffness measurement, endoscopy and assessment of portal pressure (derived from the hepatic venous pressure gradient) can facilitate risk stratification. Traditional prognostic scoring systems including the Child-Turcotte-Pugh and Model for End-stage Liver Disease are helpful but may overestimate surgical risk. Specific prognostic scores like Mayo Risk Score, VOCAL-Penn and ADOPT-LC can add precision to risk assessment. Measures to mitigate risk include careful management of varices, nutritional optimisation and where possible addressing any ongoing aetiological drivers such as alcohol consumption. The role of portal decompression such as transjugular intrahepatic portosystemic shunting can be considered in selected high-risk patients, but further prospective study of this approach is required. It is of paramount importance that patients are discussed in a multidisciplinary forum, and that patients are carefully counselled about potential risks and benefits.