New persistent opioid use after colorectal surgery in Sweden: A nationwide register-based cohort study.
Emergingsuggested applicable standard· American Gastroenterological Association, 'AGA Clinical Practice Update on Surgical Risk Assessment and Perioperative Management in Cirrhosis: Expert Review' (Northup PG et al., Clin Gastroenterol Hepatol 2019;17(4):595-606). DOI 10.1016/j.cgh.2018.09.043, PMID 30273751.
Decision at stakeperioperative opioid management in elective colorectal surgery
… Defer elective surgery for active GI bleeding, active IBD flare, recent pancreatitis, or unoptimized anemia, and specify perioperative precautions (stress-dose steroids, biologic hold matrix, GLP-1/SGLT2 holds, aspiration precautions) where indicated.
From our summary of this standard, unedited — the part the paper bears on. … marks omitted text. Our wording, not the guideline's; read the source for its own text.
Our full summary of this standard
Determine GI surgical clearance based on the specific condition and its activity rather than an automatic sign-off: most stable chronic GI conditions (GERD, IBS, controlled IBD, compensated MASLD, asymptomatic gallstones) may be cleared, while active conditions, cirrhosis, and perioperative drug management require explicit stratification and documentation. For any cirrhotic patient, perform mandatory risk stratification with VOCAL-Penn and Child-Pugh class before clearance; manage variceal prophylaxis per individualized endoscopic and hemodynamic assessment (including NSBB for appropriate candidates) and address rebalanced hemostasis without prophylactic INR correction. Defer elective surgery for active GI bleeding, active IBD flare, recent pancreatitis, or unoptimized anemia, and specify perioperative precautions (stress-dose steroids, biologic hold matrix, GLP-1/SGLT2 holds, aspiration precautions) where indicated.