Veterans Outcomes and Costs Associated With Liver Disease (VOCAL)-Penn Score

Do not use this tool as the sole determinant of surgical candidacy; integrate medical necessity, specialist input (e.g., gastroenterology/hepatology), and clinical judgment.

• Optimize modifiable risks in all patients: 
  
  • Ensure adequate nutrition and supplement deficiencies.
  • Manage portal hypertension and ascites.
  • Provide appropriate variceal prophylaxis.
  • Correct electrolyte abnormalities.
  • Use venous thromboprophylaxis when appropriate.
• For lower-risk patients: Proceed with standard optimization.
• For higher-risk patients:
  
  • Select care venues with enhanced resources and specialist support.
  • Plan for enhanced postoperative monitoring.
  • Consider minimally invasive approaches or nonsurgical alternatives when feasible.