NOTE: This module is currently in the process of being updated and recertified, and so does not currently offer CME. A fully updated module eligible for CME is expected to be available February 2024.

Ryan Munyon, MD 

Based off the original module, Evaluation and Management of Perioperative Cirrhosis by Amir A. Qamar, MD.

If you are a Program Director and would like to grant access to your trainees, please reach out to education@hospitalmedicine.org for an academic access code.

Summary

Patients with liver disease who undergo surgery, whether elective or emergent, are at increased risk for complications. In patients with cirrhosis, perioperative morbidity and mortality vary depending on the type of surgery. An accurate assessment of the presence and severity of acute or chronic liver disease is necessary to plan for perioperative management. Although most patients should continue liver-directed therapies, adjustments in medications may be necessary for certain liver diseases. This module outlines the risk associated with different types of surgery and identifies the elements of the preoperative evaluation for patients with cirrhosis. The influences on morbidity and mortality and formulation of pre- and postoperative care plans are reviewed as well.

Goal

To provide hospitalists with up-to-date information about perioperative cirrhosis management.

Target Audience

This activity is designed for hospitalists. No prerequisites required.

Learning Objectives

After completing the module, the participant will demonstrate the ability to:

1. Evaluate whether liver disease severity influences perioperative morbidity and mortality.
2. Outline the risk associated with different types of surgery in patients with cirrhosis.
3. Identify the elements of the preoperative evaluation for a patient with cirrhosis including how to manage medications on the day of surgery.
4. Formulate a perioperative care plan for the patient with cirrhosis based on the underlying severity of disease including how to manage medications.

Accreditation Statement

The Society of Hospital Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designator Statement

The Society of Hospital Medicine designates this activity for a maximum of 2.0 AMA PRA Category 1 Credit(s)^TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Release date: December 12, 2019

Expiration date: December 12, 2022

Estimated time to complete activity: 2 hours

SHM Conflict of Interest Disclosure Policy

In accordance with the ACCME Standards for Commercial Support, SHM requires that individuals in a position to control the content of an educational activity disclose all relevant financial relationships with any commercial interest. SHM mitigates all conflicts of interest to ensure independence, objectivity, balance, and scientific rigor in all its educational programs. All relevant financial relationships shall be disclosed to participants prior to the start of the activity.

Furthermore, SHM seeks to verify that all scientific research referred to, reported, or used in a continuing medical education (CME) activity conforms to the generally accepted standards of experimental design, data collection, and analysis. SHM is committed to providing its learners with high-quality CME activities that promote improvements in healthcare and not those of a commercial interest.

Instructions

The following is an interactive educational module designed to help you gauge your basic knowledge of the topic and then direct you to areas you may need to focus on. It consists of several sections: a pre-test, a study program, a post-test, & a CME evaluation. All sections must be completed to receive CME credit.