lifeMDPIReviewClinical Guideline on Perioperative Management of Patientswith Advanced Chronic Liver DiseaseLidia Canillas 1,2,3,Amalia Pelegrina 1,3,4,Juan Alvarez 3,5,Elena Colominas-Gonzalez 1,6,Antonio Salar7,Lluis Aguilera 3,5,Fernando Burdio 1,34,Antonio Montes 13,5,Santiago Grau 16,Luis Grande4,8and Jose A.Carrion 1,2,3,*Department of Medicine and Life Sciences,Universitat Pompeu Fabra,08003 Barcelona,Spain2Liver Section,Gastroenterology Department,Hospital del Mar,08003 Barcelona,Spain3IMIM(Hospital del Mar Medical Research Institute),0803 Barcelona,Spain4Department of Surgery,Hospital del Mar,08003 Barcelona,Spain5Anesthesia Department,Hospital del Mar,08003 Barcelona,SpainPharmacy Department,Hospitaldel Mar,08003 Barcelona,Spain7Haematology Department,Hospital del Mar,08003 Barcelona,SpainDepartment de Medicina,Universitat Autonoma de Barcelona,08003 Barcelona,SpainCorrespondence:jcarrion@psmar.cat:Tel.:+93-248-3220:Fax:+93-221-8644Abstract:(1)Background:Patients with advanced chronic liver disease(ACLD)are living longer withmore comorbidities because of improved medical and surgical management.However,patients withACLD are at increased risk of perioperative morbidity and mortality;(2)Methods:We conducted acomprehensive review of the literature to support a narrative clinical guideline about the assessmentof mortality risk and management of perioperative morbidity in patients with ACLD undergoingsurgical procedures;(3)Results:Slight data exist to guide the perioperative management of patientswith ACLD,and most recommendations are based on case series and expert opinion.The severity ofupdatesliver dysfunction,portal hypertension,cardiopulmonary and renal comorbidities,and complexity ofsurgery and type(elective versus emergent)are predictors of perioperative morbidity and mortality.Citation:Canillas,L;Pelegrina,A;Expert multidisciplinary teams are necessary to evaluate and manage ACLD before,during,and afterAlvarez,J;Colominas-Gonzalez,Esurgical procedures;(4)Conclusions:This clinical practice document updates the available data andSalar,A;Aguilera,L;Burdio,E;recommendations to optimize the management of patients with advanced chronic liver disease whoMontes,A Grau,S.;Grande,L;et alundergo surgical procedures.Clinical Guideline on PerioperativeManagement of Patients withKeywords:hepatic;surgery;mortality;riskAdvanced Chronic Liver Disease.Life2023,13,132 https://doiorg/103390/1ife13010132Academic Editors:Leonardo Roever1.Introductionand Giuseppe Biondi ZoccaiCirrhosis or advanced chronic liver disease(ACLD)of any etiology is the end-stageReceived:28 November 2022and the key risk factor for the development of hepatocellular carcinoma(HCC).ACLD isRevised:27 December 2022the third cause of mortality in people aged 45 to 64,and together with HCC is responsibleAcoepted:28 December 2(22for 3.5%of deaths globally [1].Frequent etiologies are metabolic-associated fatty liverPublished:3January 2(23disease(MAFLD),alcohol liver disease,and viral hepat
