title: Outcomes of abdominal surgery in patients with liver cirrhosis.
abstract: Patients suffering from liver cirrhosis (LC) frequently require non-hepatic abdominal surgery, even before liver transplantation. LC is an important risk factor itself for surgery, due to the higher than average associated morbidity and mortality. This high surgical risk occurs because of the pathophysiology of liver disease itself and to the presence of contributing factors, such as coagulopathy, poor nutritional status, adaptive immune dysfunction, cirrhotic cardiomyopathy, and renal and pulmonary dysfunction, which all lead to poor outcomes. Careful evaluation of these factors and the degree of liver disease can help to reduce the development of complications both during and after abdominal surgery. In the emergency setting, with the presence of decompensated LC, alcoholic hepatitis, severe/advanced LC, and significant extrahepatic organ dysfunction conservative management is preferred. A multidisciplinary, individualized, and specialized approach can improve outcomes; preoperative optimization after risk stratification and careful management are mandatory before surgery. Laparoscopic techniques can also improve outcomes. We review the impact of LC on surgical outcome in non-hepatic abdominal surgeries required in this cirrhotic population before, during, and after surgery.
authors.affiliation: Juan C Lopez-Delgado, Josep Ballus, Francisco Esteve, Nelson L Betancur-Zambrano, Vicente Corral-Velez, Rafael Mañez, Hospital Universitari de Bellvitge, Intensive Care Department, L'Hospitalet de Llobregat, 08907 Barcelona, Spain.
authors.forename: Juan C
authors.initials: JC
authors.lastname: Lopez-Delgado
authors.affiliation: Juan C Lopez-Delgado, Josep Ballus, Francisco Esteve, Nelson L Betancur-Zambrano, Vicente Corral-Velez, Rafael Mañez, Hospital Universitari de Bellvitge, Intensive Care Department, L'Hospitalet de Llobregat, 08907 Barcelona, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Ballus
authors.affiliation: Juan C Lopez-Delgado, Josep Ballus, Francisco Esteve, Nelson L Betancur-Zambrano, Vicente Corral-Velez, Rafael Mañez, Hospital Universitari de Bellvitge, Intensive Care Department, L'Hospitalet de Llobregat, 08907 Barcelona, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Esteve
authors.affiliation: Juan C Lopez-Delgado, Josep Ballus, Francisco Esteve, Nelson L Betancur-Zambrano, Vicente Corral-Velez, Rafael Mañez, Hospital Universitari de Bellvitge, Intensive Care Department, L'Hospitalet de Llobregat, 08907 Barcelona, Spain.
authors.forename: Nelson L
authors.initials: NL
authors.lastname: Betancur-Zambrano
authors.affiliation: Juan C Lopez-Delgado, Josep Ballus, Francisco Esteve, Nelson L Betancur-Zambrano, Vicente Corral-Velez, Rafael Mañez, Hospital Universitari de Bellvitge, Intensive Care Department, L'Hospitalet de Llobregat, 08907 Barcelona, Spain.
authors.forename: Vicente
authors.initials: V
authors.lastname: Corral-Velez
authors.affiliation: Juan C Lopez-Delgado, Josep Ballus, Francisco Esteve, Nelson L Betancur-Zambrano, Vicente Corral-Velez, Rafael Mañez, Hospital Universitari de Bellvitge, Intensive Care Department, L'Hospitalet de Llobregat, 08907 Barcelona, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Mañez
authors.affiliation: Juan C Lopez-Delgado, Josep Ballus, Francisco Esteve, Nelson L Betancur-Zambrano, Vicente Corral-Velez, Rafael Mañez, Hospital Universitari de Bellvitge, Intensive Care Department, L'Hospitalet de Llobregat, 08907 Barcelona, Spain.
authors.forename: Antoni J
authors.initials: AJ
authors.lastname: Betbese
authors.affiliation: Juan C Lopez-Delgado, Josep Ballus, Francisco Esteve, Nelson L Betancur-Zambrano, Vicente Corral-Velez, Rafael Mañez, Hospital Universitari de Bellvitge, Intensive Care Department, L'Hospitalet de Llobregat, 08907 Barcelona, Spain.
authors.forename: Joan A
authors.initials: JA
authors.lastname: Roncal
authors.affiliation: Juan C Lopez-Delgado, Josep Ballus, Francisco Esteve, Nelson L Betancur-Zambrano, Vicente Corral-Velez, Rafael Mañez, Hospital Universitari de Bellvitge, Intensive Care Department, L'Hospitalet de Llobregat, 08907 Barcelona, Spain.
authors.forename: Casimiro
authors.initials: C
authors.lastname: Javierre
mesh_terms: D000005:Abdomen / Q000601:surgery*; D006304:Health Status; D006801:Humans; D007813:Laparotomy / Q000009:adverse effects / Q000401:mortality; D008103:Liver Cirrhosis / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D019990:Perioperative Care; D011183:Postoperative Complications / Q000209:etiology; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Abdominal surgery; Adaptive immune dysfunction; Cirrhotic cardiomyopathy; Coagulopathy; Liver cirrhosis; Nutritional status; Outcomes