{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T19:58:52Z","timestamp":1792180732761,"version":"4.4.0"},"reference-count":114,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2023,1,3]],"date-time":"2023-01-03T00:00:00Z","timestamp":1672704000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>(1) Background: Patients with advanced chronic liver disease (ACLD) are living longer with more comorbidities because of improved medical and surgical management. However, patients with ACLD are at increased risk of perioperative morbidity and mortality; (2) Methods: We conducted a comprehensive review of the literature to support a narrative clinical guideline about the assessment of mortality risk and management of perioperative morbidity in patients with ACLD undergoing surgical procedures; (3) Results: Slight data exist to guide the perioperative management of patients with ACLD, and most recommendations are based on case series and expert opinion. The severity of liver dysfunction, portal hypertension, cardiopulmonary and renal comorbidities, and complexity of surgery and type (elective versus emergent) are predictors of perioperative morbidity and mortality. Expert multidisciplinary teams are necessary to evaluate and manage ACLD before, during, and after surgical procedures; (4) Conclusions: This clinical practice document updates the available data and recommendations to optimize the management of patients with advanced chronic liver disease who undergo surgical procedures.<\/jats:p>","DOI":"10.3390\/life13010132","type":"journal-article","created":{"date-parts":[[2023,1,4]],"date-time":"2023-01-04T01:42:44Z","timestamp":1672796564000},"page":"132","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Clinical Guideline on Perioperative Management of Patients with Advanced Chronic Liver Disease"],"prefix":"10.3390","volume":"13","author":[{"given":"Lidia","family":"Canillas","sequence":"first","affiliation":[{"name":"Department of Medicine and Life Sciences, Universitat Pompeu Fabra, 08003 Barcelona, Spain"},{"name":"Liver Section, Gastroenterology Department, Hospital del Mar, 08003 Barcelona, Spain"},{"name":"IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amalia","family":"Pelegrina","sequence":"additional","affiliation":[{"name":"Department of Medicine and Life Sciences, Universitat Pompeu Fabra, 08003 Barcelona, Spain"},{"name":"IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain"},{"name":"Department of Surgery, Hospital del Mar, 08003 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"\u00c1lvarez","sequence":"additional","affiliation":[{"name":"IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain"},{"name":"Anesthesia Department, Hospital del Mar, 08003 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Colominas-Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"Department of Medicine and Life Sciences, Universitat Pompeu Fabra, 08003 Barcelona, Spain"},{"name":"Pharmacy Department, Hospital del Mar, 08003 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Salar","sequence":"additional","affiliation":[{"name":"Haematology Department, Hospital del Mar, 08003 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Llu\u00eds","family":"Aguilera","sequence":"additional","affiliation":[{"name":"IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain"},{"name":"Anesthesia Department, Hospital del Mar, 08003 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernando","family":"Burdio","sequence":"additional","affiliation":[{"name":"Department of Medicine and Life Sciences, Universitat Pompeu Fabra, 08003 Barcelona, Spain"},{"name":"IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain"},{"name":"Department of Surgery, Hospital del Mar, 08003 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Montes","sequence":"additional","affiliation":[{"name":"Department of Medicine and Life Sciences, Universitat Pompeu Fabra, 08003 Barcelona, Spain"},{"name":"IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain"},{"name":"Anesthesia Department, Hospital del Mar, 08003 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8428-1836","authenticated-orcid":false,"given":"Santiago","family":"Grau","sequence":"additional","affiliation":[{"name":"Department of Medicine and Life Sciences, Universitat Pompeu Fabra, 08003 Barcelona, Spain"},{"name":"Pharmacy Department, Hospital del Mar, 08003 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis","family":"Grande","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hospital del Mar, 08003 Barcelona, Spain"},{"name":"Department de Medicina, Universitat Aut\u00f2noma de Barcelona, 08003 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7191-6081","authenticated-orcid":false,"given":"Jos\u00e9 A.","family":"Carri\u00f3n","sequence":"additional","affiliation":[{"name":"Department of Medicine and Life Sciences, Universitat Pompeu Fabra, 08003 Barcelona, Spain"},{"name":"Liver Section, Gastroenterology Department, Hospital del Mar, 08003 Barcelona, Spain"},{"name":"IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/j.jhep.2018.09.014","article-title":"Burden of liver diseases in the world","volume":"70","author":"Asrani","year":"2019","journal-title":"J. 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