Cirrhosis and the surgical patient

Cirrhosis can be challenging to recognize and manage in the perioperative setting. The Fibrosis 4 (FIB-4) score is a screening test that can help determine the likelihood of underlying advanced fibrosis or cirrhosis in patients with chronic liver disease. Liver stiffness correlates with severity of fibrosis and cirrhosis and can be measured noninvasively with transient elastography or MR elastography; a normal liver stiffness effectively rules out cirrhosis. Perioperative risk calculators include the Child-Turcotte-Pugh Score, the Mayo Risk Score, the Veterans Outcomes and Costs Associated with Liver Disease-Penn (VOCAL-Penn) score; each has its limitations. In addition to reviewing the above tools, we will briefly discuss common perioperative dilemmas in patients with cirrhosis, including selection of patients for umbilical hernia repair or bariatric surgery, and will highlight methods to optimize patients with cirrhosis prior to surgical interventions.