title: Surgery in patients with portal hypertension: a preoperative checklist and strategies for attenuating risk.
abstract: Patients with liver disease and portal hypertension are at increased risk of complications from surgery. Recent advances have allowed better optimization of patients with cirrhosis before surgery and a reduction in postoperative complications. Despite this progress, the estimation of surgical risk in a patient with cirrhosis is challenging. The MELD score has shown promise in predicting postoperative mortality compared with the Child-Turcotte-Pugh score. This article addresses current concepts in the perioperative evaluation of patients with liver disease and portal tension, including a preoperative liver assessment (POLA) checklist that may be useful towards mitigating perioperative complications.
authors.affiliation: Icahn School of Medicine at Mount Sinai, The Mount Sinai Medical Center, Recanati/Miller Transplantation Institute, One Gustave Levy Place, Box 1104, New York, NY 10029-6574, USA.
authors.forename: Gene Y
authors.initials: GY
authors.lastname: Im
authors.affiliation: Icahn School of Medicine at Mount Sinai, The Mount Sinai Medical Center, Recanati/Miller Transplantation Institute, One Gustave Levy Place, Box 1104, New York, NY 10029-6574, USA.
authors.forename: Nir
authors.initials: N
authors.lastname: Lubezky
authors.affiliation: Icahn School of Medicine at Mount Sinai, The Mount Sinai Medical Center, Recanati/Miller Transplantation Institute, One Gustave Levy Place, Box 1104, New York, NY 10029-6574, USA.
authors.forename: Marcelo E
authors.initials: ME
authors.lastname: Facciuto
authors.affiliation: Icahn School of Medicine at Mount Sinai, The Mount Sinai Medical Center, Recanati/Miller Transplantation Institute, One Gustave Levy Place, Box 1104, New York, NY 10029-6574, USA. Electronic address: thomas.schiano@mountsinai.org.
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Schiano
mesh_terms: D057189:Checklist; D000075202:Contraindications; D017558:Elective Surgical Procedures; D006801:Humans; D006975:Hypertension, Portal / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control; D011300:Preoperative Care; D040242:Risk Reduction Behavior; D012720:Severity of Illness Index
keywords: Ascites; Checklist; Child-Turcotte-Pugh; Cirrhosis; MELD; Portal hypertension; Surgery; TIPS; Variceal bleeding