CLINICAL ANESTHETIC EVALUATION OF PATIENTS WITH CHRONIC LIVER DISEASE UNDERGOING EMERGENCY SURGERY: A SYSTEMATIC REVIEW

Introduction: Chronic liver disease represents a major anesthetic challenge in emergency surgical settings due to profound alterations in hemodynamics, coagulation, metabolism, and immune function. Patients with hepatic dysfunction are at increased risk of perioperative morbidity and mortality, particularly when surgery is unplanned and optimization time is limited. Emergency procedures amplify these risks by restricting comprehensive preoperative assessment and correction of physiological derangements. Objective: The primary objective of this systematic review was to synthesize current evidence on anesthetic evaluation and perioperative risk stratification in patients with chronic liver disease undergoing emergency surgery. Secondary objectives included evaluating the role of liver disease severity scores, identifying key predictors of adverse outcomes, assessing anesthetic management strategies, analyzing perioperative monitoring approaches, and exploring implications for multidisciplinary decision-making. Methods: A systematic search was conducted across PubMed, Scopus, Web of Science, Cochrane Library, LILACS, ClinicalTrials.gov, and the International Clinical Trials Registry Platform. Studies published within the last five years were prioritized, with eligibility expanded to ten years if fewer than ten studies were identified. Inclusion criteria encompassed clinical studies involving adult patients with chronic liver disease undergoing emergency surgical procedures and reporting anesthetic, perioperative, or outcome-related data. Data were synthesized qualitatively according to PRISMA guidelines. Results and Discussion: Twenty studies met the inclusion criteria and were analyzed in detail. The evidence consistently demonstrated that higher liver disease severity, as measured by validated scoring systems, was associated with increased perioperative complications and mortality. Hemodynamic instability, coagulopathy, renal dysfunction, and infection emerged as central determinants of adverse outcomes, underscoring the importance of structured anesthetic evaluation even in emergency contexts. Conclusion: This systematic review highlights the critical role of comprehensive yet rapid anesthetic assessment in patients with chronic liver disease requiring emergency surgery. Integration of severity scoring, targeted laboratory evaluation, and multidisciplinary collaboration appears essential to improve perioperative safety and outcomes in this high-risk population.