Title: Adverse outcomes after non-hepatic surgeries in patients with alcoholic liver diseases: a
propensity-score matched study
Version: 1 Date: 01 Mar 2022
Reviewer's report:
1. Hepatitis and cirrhosis from other etiologies affect the postoperative outcomes in the previous
study. (3, 4) Please demonstrate the underlying liver diseases in matched controlled population.
2. Liver function improves within a few months after discontinuation of alcohol. (2, 5) Therefore,
the diagnosis of alcoholic hepatitis or alcoholic liver damage 24 months before surgery might
not influence postoperative complications. Is it possible to identify patients diagnosed within
six months before surgery?
3. Liver-related complications like jaundice, hepatic coma, gastrointestinal hemorrhage, ascites
and alcohol dependence syndrome were mentioned in table 4. Please identify the ICD-9 used
to identify all terms above.
4. Intraabdominal surgery had a higher mortality rate in patients with cirrhosis. (6, 7) We
suggested further subgroup analysis comparing outcomes of patients undergoing different types
of surgery.
References
1. Eliasen M, Grønkjær M, Skov-Ettrup LS, Mikkelsen SS, Becker U, Tolstrup JS, et al.
Preoperative alcohol consumption and postoperative complications: a systematic review and
meta-analysis. 2013;258(6):930-42.
2. Northup PG, Friedman LS, Kamath PSJCG, Hepatology. AGA clinical practice update
on surgical risk assessment and perioperative management in cirrhosis: expert review.
2019;17(4):595-606.
3. Del Olmo JA, Flor-Lorente B, Flor-Civera B, Rodriguez F, Serra MA, Escudero A, et al. Risk
factors for nonhepatic surgery in patients with cirrhosis. 2003;27(6):647-52.
4. Befeler AS, Palmer DE, Hoffman M, Longo W, Solomon H, Di Bisceglie AMJAoS.
The safety of intra-abdominal surgery in patients with cirrhosis: model for end-stage
liver disease score is superior to Child-Turcotte-Pugh classification in predicting outcome.
2005;140(7):650-4.
5. Bhangui P, Laurent A, Amathieu R, Azoulay DJJoh. Assessment of risk for non-hepatic
surgery in cirrhotic patients. 2012;57(4):874-84.
6. Mansour A, Watson W, Shayani V, Pickleman JJS. Abdominal operations in patients with
cirrhosis: still a major surgical challenge. 1997;122(4):730-6.
7. Friedman LSJTotAC, Association C. Surgery in the patient with liver disease. 2010;121:192.
Title: Adverse outcomes after non-hepatic surgeries in patients with alcoholic liver diseases: a
propensity-score matched study
Version: 1 Date: 01 Mar 2022
Reviewer's report:
1. Hepatitis and cirrhosis from other etiologies affect the postoperative outcomes in the previous
study. (3, 4) Please demonstrate the underlying liver diseases in matched controlled population.
2. Liver function improves within a few months after discontinuation of alcohol. (2, 5) Therefore,
the diagnosis of alcoholic hepatitis or alcoholic liver damage 24 months before surgery might
not influence postoperative complications. Is it possible to identify patients diagnosed within
six months before surgery?
3. Liver-related complications like jaundice, hepatic coma, gastrointestinal hemorrhage, ascites
and alcohol dependence syndrome were mentioned in table 4. Please identify the ICD-9 used
to identify all terms above.
4. Intraabdominal surgery had a higher mortality rate in patients with cirrhosis. (6, 7) We
suggested further subgroup analysis comparing outcomes of patients undergoing different types
of surgery.
References
1. Eliasen M, Grønkjær M, Skov-Ettrup LS, Mikkelsen SS, Becker U, Tolstrup JS, et al.
Preoperative alcohol consumption and postoperative complications: a systematic review and
meta-analysis. 2013;258(6):930-42.
2. Northup PG, Friedman LS, Kamath PSJCG, Hepatology. AGA clinical practice update
on surgical risk assessment and perioperative management in cirrhosis: expert review.
2019;17(4):595-606.
3. Del Olmo JA, Flor-Lorente B, Flor-Civera B, Rodriguez F, Serra MA, Escudero A, et al. Risk
factors for nonhepatic surgery in patients with cirrhosis. 2003;27(6):647-52.
4. Befeler AS, Palmer DE, Hoffman M, Longo W, Solomon H, Di Bisceglie AMJAoS.
The safety of intra-abdominal surgery in patients with cirrhosis: model for end-stage
liver disease score is superior to Child-Turcotte-Pugh classification in predicting outcome.
2005;140(7):650-4.
5. Bhangui P, Laurent A, Amathieu R, Azoulay DJJoh. Assessment of risk for non-hepatic
surgery in cirrhotic patients. 2012;57(4):874-84.
6. Mansour A, Watson W, Shayani V, Pickleman JJS. Abdominal operations in patients with
cirrhosis: still a major surgical challenge. 1997;122(4):730-6.
7. Friedman LSJTotAC, Association C. Surgery in the patient with liver disease. 2010;121:192.
Please review this paper.
user
Title: Adverse outcomes after non-hepatic surgeries in patients with alcoholic liver diseases: a
propensity-score matched study
Version: 1 Date: 01 Mar 2022
Reviewer's report:
1. Hepatitis and cirrhosis from other etiologies affect the postoperative outcomes in the previous
study. (3, 4) Please demonstrate the underlying liver diseases in matched controlled population.
2. Liver function improves within a few months after discontinuation of alcohol. (2, 5) Therefore,
the diagnosis of alcoholic hepatitis or alcoholic liver damage 24 months before surgery might
not influence postoperative complications. Is it possible to identify patients diagnosed within
six months before surgery?
3. Liver-related complications like jaundice, hepatic coma, gastrointestinal hemorrhage, ascites
and alcohol dependence syndrome were mentioned in table 4. Please identify the ICD-9 used
to identify all terms above.
4. Intraabdominal surgery had a higher mortality rate in patients with cirrhosis. (6, 7) We
suggested further subgroup analysis comparing outcomes of patients undergoing different types
of surgery.
References
1. Eliasen M, Grønkjær M, Skov-Ettrup LS, Mikkelsen SS, Becker U, Tolstrup JS, et al.
Preoperative alcohol consumption and postoperative complications: a systematic review and
meta-analysis. 2013;258(6):930-42.
2. Northup PG, Friedman LS, Kamath PSJCG, Hepatology. AGA clinical practice update
on surgical risk assessment and perioperative management in cirrhosis: expert review.
2019;17(4):595-606.
3. Del Olmo JA, Flor-Lorente B, Flor-Civera B, Rodriguez F, Serra MA, Escudero A, et al. Risk
factors for nonhepatic surgery in patients with cirrhosis. 2003;27(6):647-52.
4. Befeler AS, Palmer DE, Hoffman M, Longo W, Solomon H, Di Bisceglie AMJAoS.
The safety of intra-abdominal surgery in patients with cirrhosis: model for end-stage
liver disease score is superior to Child-Turcotte-Pugh classification in predicting outcome.
2005;140(7):650-4.
5. Bhangui P, Laurent A, Amathieu R, Azoulay DJJoh. Assessment of risk for non-hepatic
surgery in cirrhotic patients. 2012;57(4):874-84.
6. Mansour A, Watson W, Shayani V, Pickleman JJS. Abdominal operations in patients with
cirrhosis: still a major surgical challenge. 1997;122(4):730-6.
7. Friedman LSJTotAC, Association C. Surgery in the patient with liver disease. 2010;121:192.
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