• Humans
• Retrospective Studies
• Male
• Female
• Middle Aged
• Portal Vein/surgery
• Aged
• Adult
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Hypertension, Portal/surgery
• Hypertension, Portal/complications
• Hypertension, Portal/etiology
• Chronic Disease
• Abdomen/surgery
• Treatment Outcome

• Humans
• Pancreatectomy/adverse effects
• Male
• Female
• Retrospective Studies
• Middle Aged
• Aged
• Liver Cirrhosis/complications
• Liver Cirrhosis/surgery
• Liver Cirrhosis/mortality
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Pancreatic Neoplasms/surgery
• Pancreatic Neoplasms/mortality
• Pancreatic Neoplasms/complications
• Treatment Outcome
• Operative Time
• Survival Rate
• Adenocarcinoma/surgery
• Adenocarcinoma/mortality
• Adenocarcinoma/complications

• ALBI
• MELD
• NSQIP
• Outcomes research

• Humans
• Male
• Female
• Middle Aged
• Aged
• Colectomy/adverse effects
• Treatment Outcome
• Risk Factors
• Serum Albumin, Human/analysis
• Bilirubin/blood
• Liver Diseases/complications
• Colonic Diseases/complications
• Colonic Diseases/surgery
• Postoperative Complications
• Ileus/etiology
• Anastomotic Leak/etiology

• eeg
• management
• pediatric acute liver failure
• prognosis
• treatment

• Anesthesia
• Cirrhosis
• Hepatitis
• Liver disease
• Perioperative

• Ascites
• Hepatic Encephalopathy
• Portal Hypertension
• TIPS

• Humans
• Hypertension, Portal
• Hepatic Encephalopathy
• Stents
• Contraindications
• Treatment Outcome
• Portasystemic Shunt, Transjugular Intrahepatic/methods
• Ascites/surgery
• Esophageal and Gastric Varices
• Gastrointestinal Hemorrhage

• advanced chronic liver disease
• cirrhosis
• mortality
• postoperative risk
• surgery

• 18th Call for Projects 2022 for Quality Improvement of the "Parc de Salut Mar" "Programa de Qualitat del Parc de Salut Mar"

• Aspartate aminotransferase-to-platelet ratio index
• Cirrhosis
• Complications
• Liver damage
• Liver fibrosis
• Postoperative
• Total shoulder arthroplasty

• Budd-Chiari syndrome
• portal hypertension
• portal vein thrombosis
• surgery
• transjugular intrahepatic portosystemic shunt

• cirrhosis
• liver disease in pregnancy
• portal hypertension

• Humans
• Organ Transplantation
• Risk Factors

• Humans
• End Stage Liver Disease
• Severity of Illness Index
• Liver Cirrhosis/complications
• Liver Cirrhosis/surgery
• Risk Factors
• Risk Assessment

• Chronic liver disease
• cirrhosis
• morbidity
• mortality
• pancreatectomy

• ABDOMINAL SURGERY
• CIRRHOSIS
• PORTAL HYPERTENSION

• ESLD
• cirrhosis
• coagulopathy
• portal hypertension
• viscoelastic tests

Over the last decade, non-alcoholic fatty liver disease (NAFLD) has overtaken alcohol as the leading cause of cirrhosis in the Western world. There remains to be a licensed pharmacological treatment for NAFLD. Weight loss is advised for all patients with NAFLD. Many patients however, struggle to lose the recommended weight with lifestyle modification alone. Many drugs have either failed to show significant improvement of steatosis or are poorly tolerated. Bariatric surgery has been shown to reduce liver steatosis and regress liver fibrosis. The pathophysiology is not fully understood, however recent evidence has pointed towards changes in the gut microbiome following surgery. Novel endoscopic treatment options provide a minimally invasive alternative for weight loss. Randomised controlled trials are now required for further clarification.

• Obesity
• Metabolic associated fatty liver disease
• Non-alcoholic fatty liver disease
• Non-alcoholic steatohepatitis
• Bariatric endoscopy
• Bariatric surgery

• perioperative period
• risk assessment
• postoperative complications
• decision support techniques
• general surgery
• sistemas de apoio a decisões clínicas
• período perioperatório
• complicações intraoperatórias
• complicações pós-operatórias
• cirurgia geral

• Brazil
• Humans
• Postoperative Complications
• Risk Assessment
• Surgical Wound Infection

• Humans
• Kidney Diseases
• Liver Diseases/surgery
• Perioperative Care
• Preoperative Care

• Bile leakage
• Morbidity
• Mortality
• Postoperative complication
• Risk factor
• Surgical complications

• Adult
• Cysts/epidemiology
• Cysts/surgery
• Female
• Humans
• Liver
• Male
• Morbidity
• Retrospective Studies
• Risk Factors

• ASA, American Society of Anaesthesiologists
• CLD, Chronic liver disease
• CTP, Child-Turcotte-Pugh
• Cirrhosis
• HCC, Hepatocellular carcinoma
• HVPG, hepatic venous pressure gradient
• MELD, Model for end stage liver disease
• NASH, Non-alcoholic steatohepatitis
• ROTEM, rotational thromboelastometry
• Surgery in cirrhosis
• Surgical risk assessment
• TEG, Thromboelastography
• VOCAL-Penn score, Veterans Outcomes and Costs Associated with Liver Disease-Penn score

Hepatic dysfunction (HD) is a common complication that can occur after surgical repair of acute type A aortic dissection (ATAAD) and is associated with poor prognosis. However, the incidence of early preoperative HD and the associated risk factors in patients with ATAAD have not been fully elucidated.

A total of 984 ATAAD patients who received surgical repair within 48 hours of symptom onset at our department from January 2014 to December 2019 were retrospectively analyzed. Patients were divided into the non-HD group and the HD groups according to the Model of End-Stage Liver Disease (MELD) score before surgery. The clinical parameters and clinical outcomes of the 2 groups were collected and compared.

Preoperative HD was detected in 268 patients (27.2%). The incidence of in-hospital complications, including the need for dialysis (34.0% vs. 9.2%; P<0.001), was significantly higher in patients with HD compared to patients without HD (69.8% vs. 51.0%; P<0.001). Patients with HD had a higher 30-day mortality rate compared to patients without HD (20.1% vs. 8.4%; P<0.001). Multivariate analysis demonstrated that preoperative cardiac tamponade, preoperative serum creatinine levels, and serum troponin T levels upon admission were independent predictors for preoperative HD in patients with ATAAD. Interestingly, even though preoperative HD was associated with an increased 30-day mortality rate, it did not significantly affect the long-term mortality rate (log-rank P=0.259).

Early HD before surgery was commonly observed in patients with ATAAD and was associated with increased in-hospital complications after surgery, but did not significantly affect long-term survival.

• Hepatic dysfunction (HD)
• outcomes
• risk factors
• type A aortic dissection

• autoregulation
• blood pressure
• hypotension
• organ perfusion
• outcome
• pathophysiology
• perfusion

To establish a nomogram based on inflammatory indices and ICG-R15 for predicting post-hepatectomy liver failure (PHLF) among patients with resectable hepatocellular carcinoma (HCC).

A retrospective cohort of 407 patients with HCC hospitalized at Xiangya Hospital of Central South University between January 2015 and December 2020, and 81 patients with HCC hospitalized at the Second Xiangya Hospital of Central South University between January 2019 and January 2020 were included in the study. Totally 488 HCC patients were divided into the training cohort (n=378) and the validation cohort (n=110) by random sampling. Univariate and multivariate analysis was performed to identify the independent risk factors. Through combining these independent risk factors, a nomogram was established for the prediction of PHLF. The accuracy of the nomogram was evaluated and compared with traditional models, like CP score (Child-Pugh), MELD score (Model of End-Stage Liver Disease), and ALBI score (albumin-bilirubin) by using receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA).

Cirrhosis (OR=2.203, 95%CI:1.070-3.824, P=0.030), prothrombin time (PT) (OR=1.886, 95%CI: 1.107-3.211, P=0.020), tumor size (OR=1.107, 95%CI: 1.022-1.200, P=0.013), ICG-R15% (OR=1.141, 95%CI: 1.070-1.216, P<0.001), blood loss (OR=2.415, 95%CI: 1.306-4.468, P=0.005) and AST-to-platelet ratio index (APRI) (OR=4.652, 95%CI: 1.432-15.112, P=0.011) were independent risk factors of PHLF. Nomogram was built with well-fitted calibration curves on the of these 6 factors. Comparing with CP score (C-index=0.582, 95%CI, 0.523-0.640), ALBI score (C-index=0.670, 95%CI, 0.615-0.725) and MELD score (C-ibasedndex=0.661, 95%CI, 0.606-0.716), the nomogram showed a better predictive value, with a C-index of 0.845 (95%CI, 0.806-0.884). The results were consistent in the validation cohort. DCA confirmed the conclusion as well.

A novel nomogram was established to predict PHLF in HCC patients. The nomogram showed a strong predictive efficiency and would be a convenient tool for us to facilitate clinical decisions.

• APRI
• ICG-R15
• hepatocellular carcinoma
• nomogram
• post-hepatectomy liver failure

• Liver cirrhosis
• Mayo risk score
• Patient selection
• Postoperative complications
• Risk assessment
• Surgery

Patients with liver cirrhosis have an increased risk of in-hospital mortality or postoperative complication after surgery. However, large-scale studies on the prognosis of these patients after surgery are lacking. The aim of the study was to investigate the adverse outcomes of patients with liver cirrhosis after surgery over five years.

We used the Health Insurance Review and Assessment Service-National Inpatient Samples (HIRA-NIS) between 2012 and 2016. In-hospital mortality and hospital stay were analyzed using the data. Mortality rates according to the surgical department were also analyzed. Of the 1,662,887 patients who underwent surgery, 16,174 (1.0%) patients had cirrhosis. The in-hospital mortality (8.0% vs. 1.0%) and postoperative complications such as respiratory (6.0% vs. 5.3%) or infections (2.8% vs. 2.4%) was significantly higher in patients with cirrhosis than in those without cirrhosis. In addition, the total hospitalization period and use of the intensive care unit were significantly higher in patients with liver cirrhosis. In propensity score matching analysis, liver cirrhosis increased the risk of adverse outcome significantly [adjusted OR (aOR) 1.67, 95% CI 1.56–1.79, P<0.001], especially in-hospital mortality. In liver cirrhosis group, presence of decompensation or varices showed significantly increased postoperative complication or mortality. Adverse outcomes in patients with cirrhosis was the highest in patients who underwent otorhinolaryngology surgery (aOR 1.86), followed by neurosurgery (aOR 1.72), thoracic and cardiovascular surgery (aOR 1.56), and plastic surgery (aOR 1.36).

The adverse outcomes of patients with cirrhosis is significantly high after surgery, despite advances in cirrhosis treatment.

• Aged
• Anesthesia
• Female
• Hospital Mortality
• Humans
• Intensive Care Units
• Length of Stay
• Liver/pathology
• Liver/surgery
• Liver Cirrhosis/epidemiology
• Liver Cirrhosis/pathology
• Liver Cirrhosis/surgery
• Male
• Middle Aged
• Mortality
• Prognosis
• Republic of Korea/epidemiology
• Risk Assessment
• Risk Factors

• Soonchunhyang University research fund
• Hanmi Pharm. Co

• National Surgical Quality Improvement Program
• chronic liver disease
• outcomes

• National Health Insurance Research Database
• chronic liver disease
• hip fractures
• osteoporotic fractures

• 10 cm
• Hepatectomy
• Hepatocellular carcinoma
• Huge
• Laparoscopic
• Liver resection

Millions of Americans have hepatitis C and other liver diseases, many of whom have end-stage osteoarthritis requiring total joint arthroplasty (TJA). This study aimed to determine the extent to which hepatitis C and other liver diseases are independent risk factors for complications, including readmission and reoperation, in patients undergoing TJA.

Retrospective study of a REACHnet data set containing demographics, International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) codes, and clinical and laboratory data for patients who underwent primary total knee or hip replacement from 2013 to 2017 at 3 hospital systems in Louisiana and Texas. Multivariable logistic regression analyses examined predictors of complications. Any complication was defined as a 90-day medical complication or readmission or reoperation within 1 year.

Among 13,673 patients who met inclusion criteria, 14.9% (2044/13,673) had any complication, 11.7% (1600/13,673) were readmitted within 90 days, and 3.6% (497/13,673) had a reoperation within 1 year. Liver disease increased the odds for any complication (odds ratio [OR], 1.12; 95% confidence interval [CI], 1.08-1.18), 90-day medical complication (OR, 1.13; 95% CI, 1.04-1.22), and 90-day readmission (OR, 1.11; 95% CI, 1.06-1.17). Hepatitis C was not, by itself, associated with an increase in any type of complication but was usually associated with liver disease. Comorbidity severity was the strongest predictor of all types of complications after TJA.

Patients in Louisiana and Texas with liver disease were at increased risk for complications after TJA, corroborating findings of previous studies. Hepatitis C was not an independent predictor of complications because of its high association with liver disease.

• Complications
• Hepatitis C
• Liver disease
• Total hip arthroplasty
• Total knee arthroplasty

Intraoperative hypotension, with varying definitions in literature, may be associated with postoperative complications. The aim of this meta-analysis was to assess the association of intraoperative hypotension with postoperative morbidity and mortality.

MEDLINE, Embase and Cochrane databases were searched for studies published between January 1990 and August 2018. The primary endpoints were postoperative overall morbidity and mortality. Secondary endpoints were postoperative cardiac outcomes, acute kidney injury, stroke, delirium, surgical outcomes and combined outcomes. Subgroup analyses, sensitivity analyses and a meta-regression were performed to test the robustness of the results and to explore heterogeneity.

The search identified 2931 studies, of which 29 were included in the meta-analysis, consisting of 130 862 patients. Intraoperative hypotension was associated with an increased risk of morbidity (odds ratio (OR) 2.08, 95 per cent confidence interval 1.56 to 2.77) and mortality (OR 1.94, 1.32 to 2.84). In the secondary analyses, intraoperative hypotension was associated with cardiac complications (OR 2.44, 1.52 to 3.93) and acute kidney injury (OR 2.69, 1.31 to 5.55). Overall heterogeneity was high, with an I² value of 88 per cent. When hypotension severity, outcome severity and study population variables were added to the meta-regression, heterogeneity was reduced to 50 per cent.

Intraoperative hypotension during non-cardiac surgery is associated with postoperative cardiac and renal morbidity, and mortality. A universally accepted standard definition of hypotension would facilitate further research into this topic.

• Anesthesia
• Anesthesia considerations
• End-stage liver disease
• Liver failure

It is well known that the incidence of liver cirrhosis is increasing and it negatively affects outcome after surgery. While there are several studies investigating the influence of liver cirrhosis on colorectal, hepatobiliary, or hernia surgery, data about its impact on small bowel surgery are completely lacking. Therefore, a retrospective analysis over a period of 17 years was performed including 76 patients with liver cirrhosis and small bowel surgery. Postsurgical complications were analyzed, and 38 parameters as possible predictive factors for a worse outcome were investigated. We observed postsurgical complications in over 90% of the patients; in over 50%, the complications were classified as severe. When subdividing postoperative complications, bleeding, respiratory problems, wound healing disorders and anastomotic leakage, hydropic decompensation, and renal failure were most common. The most important predictive factors for those complications after uni- and multivariate analysis were portal hypertension, poor liver function, emergency or additional surgery, ascites, and high ASA score. We, therefore, recommend treatment of portal hypertension before small bowel surgery to avoid extension of the operation to other organs than the small bowel and in case of ascites to evaluate the creation of an anastomosis stoma instead of an unprotected anastomosis to prevent leakages.

(1) Purpose: As it is known, patients with liver cirrhosis (LC) undergoing colon surgery or hernia surgery have high perioperative morbidity and mortality. However, data about patients with LC undergoing small bowel surgery is lacking. This study aimed to analyze the morbidity and mortality of patients with LC after small bowel surgery in order to determine predictive risk factors for a poor outcome. (2) Methods: A retrospective analysis was performed of all patients undergoing small bowel surgery between January 2002 and July 2018 and identified 76 patients with LC. Postoperative complications were analyzed using the classification of Dindo/Clavien (D/C) and further subdivided (hemorrhage, pulmonary complication, wound healing disturbances, renal failure). A total of 38 possible predictive factors underwent univariate and multivariate analyses for different postoperative complications and in-hospital mortality. (3) Results: Postoperative complications [D/C grade ≥ II] occurred in 90.8% of patients and severe complications (D/C grade ≥ IIIB) in 53.9% of patients. Nine patients (11.8%) died during the postoperative course. Predictive factors for overall complications were “additional surgery” (OR 5.3) and “bowel anastomosis” (OR 5.6). For postoperative mortality, we identified the model of end-stage liver disease (MELD) score (OR 1.3) and portal hypertension (OR 5.8) as predictors. The most common complication was hemorrhage, followed by pulmonary complications, hydropic decompensation, renal failure, and wound healing disturbances. The most common risk factors for those complications were portal hypertension (PH), poor liver function, emergency or additional surgery, ascites, and high ASA score. (4) Conclusions: LC has a devastating influence on patients’ outcomes after small bowel resection. PH, poor liver function, high ASA score, and additional or emergency surgery as well as ascites were significant risk factors for worse outcomes. Therefore, PH should be treated before surgery whenever possible. Expansion of the operation should be avoided whenever possible and in case of at least moderate preoperative ascites, the creation of an anastomotic ostomy should be evaluated to prevent leakages.

• Keywords: small bowel surgery
• liver cirrhosis
• perioperative morbidity
• perioperative mortality
• risk factors

Systemic sclerosis or scleroderma (SSc) is a systemic, immune-mediated disease characterized by abnormal cutaneous and organ-based fibrosis that results in progressive end-organ dysfunction and decreased survival. SSc results in significant challenges for the practicing anesthesiologist due to its rarity, multi-system involvement, and limited evidence-based guidance for optimal perioperative care. In this update, we briefly discuss the recent evidence on the pathophysiology and current management of SSc, review the anesthesia-related literature, and extrapolate these observations into an optimal perioperative strategy for the care of SSc patients.

Evidence shows that patients with SSc demonstrate an increased risk for perioperative myocardial infarction, high rates of interstitial lung disease, pulmonary arterial hypertension, neurological disease, gastric dysmotility disorders, and challenging airway management, all findings that may result in suboptimal perioperative outcomes.

Advances in SSc medical management have resulted in improved survival, likely increasing the number of patients who will be exposed to perioperative care. Optimal perioperative management and risk stratification should expand beyond the well-described airway challenges and consider numerous systemic manifestations of systemic sclerosis such as pulmonary arterial hypertension, interstitial lung disease, and cardiac sequelae.

• Anesthesia
• Perioperative
• Scleroderma
• Systemic sclerosis

• UL1 TR001863 NCATS NIH HHS

• Cirrhosis
• Hernia repair
• Inguinal hernia
• Liver transplant

• Bariatric morbidity
• Bariatric surgery
• Liver cirrhosis
• Non-alcoholic steatohepatitis (NASH)

• Bariatric Surgery
• Case-Control Studies
• Child
• Diabetes Mellitus, Type 2/complications
• Gastrectomy
• Gastric Bypass
• Humans
• Laparoscopy
• Liver Cirrhosis/epidemiology
• Middle Aged
• Obesity, Morbid/surgery
• Retrospective Studies
• Treatment Outcome

• Hepatitis C virus
• Hepatocellular carcinoma
• Liver resection
• Post-hepatectomy liver failure

• Carcinoma, Hepatocellular/surgery
• Hepatectomy/adverse effects
• Humans
• Liver Failure/epidemiology
• Liver Failure/etiology
• Liver Neoplasms/surgery
• Retrospective Studies

The management of patients with colorectal cancer (CRC) who have liver cirrhosis (LC) requires a thorough understanding of both diseases; however, the prognoses and postoperative outcomes of such patients remain understudied. We investigated the effect of LC on surgical and oncologic outcomes in patients with CRC, and identified prognostic factors.

We analyzed 453 patients with CRC and LC (CRC-LC group), 906 with CRC only (CRC group), 906 with LC only (LC group), and 1,812 healthy subjects using health insurance claim data (2008–2013).

The CRC-LC group had a higher frequency of intensive care unit admission than the CRC group; there were no differences between the 2 groups in terms of early and late postoperative small bowel obstruction and incisional hernia. However, the 30-day, 60-day, and 90-day mortality rates were all significantly higher in the CRC-LC group. The higher Charlson comorbidity index (hazard ratio [HR], 1.127) and the lower socioeconomic status (HR, 0.985) were significant worse predictors of 5-year survival. Patients with underlying LC had a significantly higher HR in both the advanced CRC (HR, 1.858) and nonadvanced CRC (HR, 1.799) subgroups. However, the nonadvanced CRC subgroup showed a lower HR than the LC group (HR, 0.730).

Patients with CRC who had underlying LC had a lower survival rate than did those without LC, although the incidence rates of postoperative complications were not significantly different. The presence of LC was associated with a significantly lower survival rate regardless of CRC presence.

• Colorectal neoplasms
• Complication
• Liver cirrhosis
• Oncological results

• cirrhosis
• hepatectomy
• hepatocellular carcinoma
• laparoscopy
• liver surgery
• portal hypertension
• robotic