Clinical Tools
VOCAL Penn Cirrhosis Surgical Risk Score
Surgery Types
Representative examples of procedures included in different surgery categories:
| Category | Examples |
|---|---|
| Abdominal | Cholecystectomy, exploratory laparotomy, colectomy, laparoscopy for diagnosis or washout, appendectomy, pancreatectomy |
| Abdominal Wall | Inguinal hernia repair, umbilical hernia repair, incisional/ventral hernia repair |
| Vascular | Aortic aneurysm repair, bypass graft (femoral-popliteal, femoral-femoral), endovascular aortic repair, thromboendarterectomy (carotid, vertebral, femoral, subclavian) |
| Major Orthopedic | Total knee arthroplasty, total hip arthroplasty, amputation through femur, amputation through tibia/fibula, open treatment of femoral neck fracture with internal fixation |
| Chest/Cardiac | Pulmonary lobectomy, thoracoscopy with lobectomy, pleurodesis, wedge resection, aortic valve replacement (with cardiopulmonary bypass), coronary artery bypass graft, mitral valve replacement (with cardiopulmonary bypass) |
* Notable exclusions:
- patients undergoing liver-specific surgeries such as partial hepatic resections
- patients receiving endovascular valve replacements such as transcatheter aortic valve replacement (TAVR)
About
Evidence
Mahmud N, Fricker Z, Hubbard RA, Ioannou GN, Lewis JD, Taddei TH, Rothstein KD, Serper M, Goldberg DS, Kaplan DE. Novel Risk Prediction Models for Post‐Operative Mortality in Patients with Cirrhosis. Hepatology. 2020 Sep 16. doi: 10.1002/hep.31558.
Mahmud N, Fricker Z, Panchal S, Lewis JD, Goldberg DS, Kaplan DE. External Validation of the VOCAL‐Penn Cirrhosis Surgical Risk Score in Two Large, Independent Health Systems. Liver Transplantation. 2021 Mar 31. doi: 10.1002/lt.26060.
Mahmud N, Fricker Z, Lewis JD, Taddei TH, Goldberg DS, Kaplan DE. Risk Prediction Models for Postoperative Decompensation and Infection in Patients With Cirrhosis: A Veterans Affairs Cohort Study. Clinical Gastroenterology and Hepatology. 2021 Jul 8. doi: 10.1016/j.cgh.2021.06.050.
Original Research
The research supporting the development of the Surgical Risk calculators was supported in part by grants:
- National Institutes of Health NIDDK: 2-T32-DK007740-21A1 (Mahmud)
- American College of Gastroenterology: ACG-JR-010-2020 (Mahmud)
- U.S. Department of Veterans Affairs: HX003062 (Ioannou)
The VOCAL-Penn models were developed and internally validated using data from the national Veterans Affairs healthcare system, including data from the Veterans Affairs Surgical Quality Improvement Program (VASQIP). External validation has been performed in two large, independent health systems. The contents do not represent the views of the US Department of Veterans Affairs of the United States Government. Learn more about VASQIP.