Malnutrition is a risk factor in cirrhotic patients undergoing surgery

• Published in: Nutrition (Burbank, Los Angeles County, Calif.) Vol. 18; no. 11; pp. 978 - 986
• Main Authors: Merli, Manuela, Nicolini, Giorgia, Angeloni, Stefania, Riggio, Oliviero
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.11.2002; Elsevier
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Emergency and intensive care: metabolism and nutrition disorders. Enteral and parenteral nutrition; Humans; Intensive care medicine; liver cirrhosis; Liver Cirrhosis - complications; Liver Cirrhosis - surgery; Liver Transplantation; Liver, biliary tract, pancreas, portal circulation, spleen; malnutrition; Medical sciences; Nutrition Disorders - complications; Nutrition Disorders - epidemiology; Nutrition Disorders - therapy; nutrition support; Nutritional Status; Nutritional Support; Perioperative Care; Postoperative Complications; Risk Factors; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; surgical risk; Treatment Outcome; malnutrition; surgical risk; liver cirrhosis; liver transplantation; nutrition support; Human; Postoperative; Nutrition; Digestive system; Liver; Nutrition disorder; Hepatic disease; Transplantation; Review; Cirrhosis; Surgery; Risk factor; Digestive diseases; Preoperative; Malnutrition; Nutritional status; Resuscitation
• ISSN: 0899-9007; 1873-1244
• DOI: 10.1016/S0899-9007(02)00984-X

Cirrhotic patients may become candidates for elective and emergency surgery. This may be due to conditions requiring operations such as cholecystectomy, herniotomy, or gastrointestinal malignancies, more common in cirrhotics when compared with the general population, or to complications of the liver disease such as resectable hepatocellular carcinomas or surgical portosystemic shunts to treat portal hypertension. It has been estimated that 10% of cirrhotics undergo at least one operative procedure during the final 2 y of their lives. Many studies have documented a high risk of morbidity and mortality associated with surgical procedures in these patients, and several factors influencing the postoperative outcome have been identified. Malnutrition, which is frequently encountered in cirrhotic patients, has been shown to have an important impact on the surgical risk. A poor nutrition status also has been associated with a higher risk of complications and mortality in patients undergoing liver transplantation. Few data are available concerning the perioperative nutrition support in surgical cirrhotic patients. The results of these studies are sometimes encouraging in reporting that the nutrition therapy may improve the clinical outcome in cirrhotic patients undergoing general surgery and/or liver transplantation. The limited number of patients and their heterogeneity, however, do not allow definitive conclusions, and more research on this issue is needed.