In a patient with cirrhosis undergoing elective surgery, which perioperative factor most influences risk?

• A. Portal hypertension and hepatic dysfunction (coagulopathy and bleeding risk)
• B. Age
• C. Type of anesthesia
• D. Prior abdominal surgery

Answer: (A)

In cirrhosis, the most important determinant of perioperative risk is the liver’s functional reserve combined with portal hypertension. The liver’s impaired ability to synthesize clotting factors and platelets leads to coagulopathy and an increased risk of bleeding during and after surgery. At the same time, portal hypertension heightens the likelihood of variceal or other bleeding and complicates hemodynamics and wound healing. These issues overshadow other factors like age, the specific anesthesia technique, or prior abdominal surgery, making hepatic dysfunction and portal hypertension the key drivers of perioperative risk in these patients.