Performance of clinical scores in predicting perioperative risk in cirrhotic patients undergoing non-hepatic surgeries

Abstract

Objective: To correlate the performance of clinical scores in predicting perioperative risk in cirrhotic patients undergoing non-hepatic surgery. Literature review: Liver cirrhosis is a clinical condition that confers a high risk of pulmonary and hemorrhagic complications and liver failure after surgery, due to multisystemic dysfunction. In order to assess perioperative risk, three scores that evaluate surgical risk were reviewed: Child-Pugh, MELD, and VOCAL-Penn. Although the Child-Pugh score is a classic and widely used system, it has limitations due to the subjectivity of ascites and encephalopathy. The MELD score uses objective laboratory variables (bilirubin, creatinine), but its accuracy declines because it disregards variables such as the type of surgery, in addition to underestimating the risk of complications in patients with less advanced cirrhosis or good residual liver function. The VOCAL-Penn score integrates disease factors, comorbidities, and surgical variables, demonstrating superior discrimination and better performance in predicting mortality, especially in the first 90 postoperative days, in addition to predicting postoperative cirrhotic decompensation. Conclusion: Can be considered that the VOCAL-Penn score is the most accurate tool for stratifying surgical risk in cirrhotic patients. It presents advantages over the Child-Pugh and MELD scores by integrating liver severity and procedure-specific factors.