P62 A multidisciplinary team approach to assessing patients with advanced chronic liver disease undergoing non-hepatological surgery in the South East of England

<h3>Introduction</h3> Patients with advanced chronic liver disease (ACLD) have approximately three-fold higher peri-operative mortality compared with patients without cirrhosis. The risk of surgical complications leading to morbidity and mortality correlates with liver disease severity, impaired synthetic function, portal hypertension and sarcopaenia.¹ With an ageing population of patients with ACLD, the volume of surgical procedures in patients with cirrhosis has increased over time. There are currently no UK guidelines to risk stratify these patients. <h3>Methods</h3> We reviewed outcomes from patients discussed in the ACLD MDT from February 2022 to February 2024 and selected patients referred for non-hepatological peri-operative optimisation. We also reviewed electronic patient records, including anaesthetic and older persons surgical liaison review. Rockwood frailty score and liver disease severity scores were calculated. <h3>Results</h3> A total of 34 patients were identified, of which 73% (25/34) were referred in the last 6 months. 9/34 of referrals were external, originating from the South East of England. Most of the patients (61%) were male with a median age of 63 (15). The median Rockwood frailty score was 3 (2). The commonest aetiologies for liver cirrhosis were alcohol 55% (20/34) and MASLD 26% (9/34). Seventy percent (24/34) had Child Pugh A cirrhosis. Median MELD was 8.5 (5.75) The most frequent indication for surgery was colorectal adenocarcinoma 55% (19/34). Portal pressure studies were performed in 14/34 (37%). Median hepatic venous-portal gradient (HVPG) was 14 (3). Five patients with clinically significant portal hypertension (HVPG&gt;15 mmHG) underwent TIPS. VOCAL-Penn Cirrhosis Surgical Risk Score (30-day mortality) was higher in patients referred for HVPG: 2% (4.15) compared to the ‘proceed with caution’ group: 0.3% (2.7), without reaching statistical significance (figure 1). Thirteen patients (of 34) have undergone surgery, two of whom developed post-operative hepatic decompensation, with one death within 30 days. Both patients were aged over 70, had HVPGs &gt;15 and were not suitable for TIPS. Median post-surgical length-of-stay was 7 days (9). There were 3 unplanned intensive care admissions and 2 prolonged hospitalisations (&gt; 30 days). <h3>Discussion</h3> With the rise in prevalence of cirrhosis, surgical procedures in those with underlying chronic liver disease are increasingly being undertaken, as evidenced by increased referrals to our service. Patient selection and risk stratification is vital for optimal outcomes. We are currently developing a peri-operative pathway to streamline assessment and guide multidisciplinary work-up. Clinical guidelines and minimum service standards in perioperative management require urgent attention and should be considered at national level. <h3>Reference</h3> Kaltenbach, M.G. and N. Mahmud, <i>Assessing the risk of surgery in patients with cirrhosis.</i> Hepatol Commun, 2023. <b>7</b>(4).