Patients with cirrhosis who have bleeding esophageal varices have fewer treatment-related complications and better survival rates when they are treated by esophageal ligation than when they are treated by sclerotherapy.

In June 1996, the American Association for the Study of Liver Diseases sponsored a single topic workshop combining a two-day symposium on liver microcirculation in health and diseases 1 followed by a two day consensus workshop on portal hypertension and variceal bleeding. The goal of the combined conference was to identify areas of critical importance in the understanding and treatment of portal hypertension and to foster future collaborative research projects.The portal hypertension-variceal bleeding conference consisted of eight panel discussions, each highlighting a specific topic related to evaluation and treatment of portal hypertension. The chair of each panel was charged to summarize the current state of knowledge in the field and to suggest areas for future investigation. In addition, there were three invited lecturers on specific areas of interest. This report will summarize the conclusions of each of the panels. In comparing the summary statements from the different panels, there may be differences in emphasis, definitions of endpoints, or choices for therapy. These differences are a reflection of the state of the field where areas of disagreement exist.

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BACKGROUND The purpose of this study was to determine the relationship of frailty and six-month post-operative costs. METHODS Subjects ≥65 years undergoing elective colorectal operations were enrolled in a prospective observational study. Frailty was assessed by a validated measure of function, cognition, nutrition, co-morbidity burden and geriatric syndromes. Frailty was quantified by summing the number of positive characteristics in each subject. RESULTS Sixty subjects (mean age 75±8 years) were studied. Inpatient mortality was 2% (n=1). Overall, 40% (n=24) of subjects were considered non-frail, 22% (n=13) were pre-frail and 38% (n=22) were frail. With advancing frailty, hospital cost increased (p<.001) and cost from discharge to six-months increased (p<.001). Higher degrees of frailty were related to increased rates of discharge institutionalization (p<.001) and thirty-day readmission (p=.044). CONCLUSIONS A simple, brief pre-operative frailty assessment accurately forecasts increased surgical hospital costs and post-discharge to six-month healthcare costs following colorectal operations in older adults.