Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, United States.
Division of Gastroenterology, Hospital of the University of Pennsylvania, Philadelphia, PA, United States; Leonard David Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States.
Ann Hepatol. 2020 Jul-Aug;19(4):341-343. doi: 10.1016/j.aohep.2020.04.005. Epub 2020 May 15.
The burden of cirrhosis is increasing, as is the need for surgeries in patients with cirrhosis. These patients have increased surgical risk relative to non-cirrhotic patients. Unfortunately, currently available cirrhosis surgical risk prediction tools are non-specific, poorly calibrated, limited in scope, and/or outdated. The Mayo score is the only dedicated tool to provide discrete post-operative mortality predictions for patients with cirrhosis, however it has several limitations. First, its single-center nature does not reflect institution-specific practices that may impact surgical risk. Second, it pre-dates major surgical changes that have changed the landscape of patient selection and surgical risk. Third, it has been shown to overestimate risk in external validation. Finally, and perhaps most importantly, the score does not account for differences in risk based on surgery type. The clinical consequences of inaccurate prediction and risk overestimation are significant, as patients with otherwise acceptable risk may be denied elective surgical procedures, thereby increasing their future need for higher-risk emergent procedures. Confident evaluation of the risks and benefits of surgery in this growing population requires an updated, generalizable, and accurate cirrhosis surgical risk calculator that incorporates the type of surgery under consideration.
肝硬化的负担正在增加，需要接受手术的肝硬化患者也在增加。与非肝硬化患者相比，这些患者的手术风险增加。不幸的是，目前可用的肝硬化手术风险预测工具特异性差、校准效果差、适用范围有限且/或已过时。Mayo 评分是唯一一种专门为肝硬化患者提供离散术后死亡率预测的工具，但它有几个局限性。首先，它的单中心性质不能反映机构特定的实践，这些实践可能会影响手术风险。其次，它是在重大手术改变之前制定的，这些改变改变了患者选择和手术风险的格局。第三，已经证明它在外部验证中高估了风险。最后，也许最重要的是，该评分并未根据手术类型来区分风险差异。不准确的预测和风险高估的临床后果是显著的，因为否则风险可以接受的患者可能会被拒绝接受择期手术，从而增加他们未来需要进行更高风险的紧急手术的可能性。为了在这个不断增长的人群中对手术的风险和获益进行有信心的评估，需要一种更新的、可推广的和准确的肝硬化手术风险计算器，该计算器应包含所考虑的手术类型。
