Skip to main content

Liver Disease and Perioperative Risk

  • Chapter
  • First Online:
The Perioperative Medicine Consult Handbook
  • 2836 Accesses

Abstract

Acute hepatitis and cirrhosis are major risk factors for complications of surgery. Patients with compensated liver disease (mild chronic hepatitis, nonalcoholic fatty liver disease, etc.) generally tolerate surgery well, but patients with severe or decompensated liver disease are at high risk for mortality. The role of the medical consultant includes preoperative risk assessment, optimization of liver disease, and prevention and management of postoperative complications.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Friedman LS. Surgery in the patient with liver disease. Trans Am Clin Climatol Assoc. 2010;121:102–204.

    Google Scholar 

  2. O’Leary JG. Surgery in the patient with liver disease. Clin Liver Dis. 2009;13(2):211–31.

    Article  PubMed  Google Scholar 

  3. Ribeireiro T, Swain J, et al. NAFLD and insulin resistance do not increase the risk of postoperative complications among patients undergoing bariatric surgery—a prospective analysis. Obes Surg. 2011;21(3):310–5.

    Article  PubMed  Google Scholar 

  4. Mansour A, Watson W, Shayani V, et al. Abdominal operations in patients with cirrhosis: still a major surgical challenge. Surgery. 1997;122(4):730–6.

    Article  CAS  PubMed  Google Scholar 

  5. Neeff H, Mariaskin D, Spangenberg HC, et al. Perioperative mortality after non-hepatic general surgery in patients with liver cirrhosis: an analysis of 138 operations in the 2000s using child and MELD scores. J Gastrointest Surg. 2011;15:1–11.

    Article  PubMed  Google Scholar 

  6. Farnsworth N, Fagan SP, Berger DH, et al. Child-Turcotte-Pugh versus MELD score as a predictor of outcome after elective and emergent surgery in cirrhotic patients. Am J Surg. 2004;188:580–3.

    Article  PubMed  Google Scholar 

  7. Perkins L, Jeffries M, Patel T. Utility of preoperative scores for predicting morbidity after cholecystectomy in patients with cirrhosis. Clin Gastroenterol Hepatol. 2004;2(12):1123–8.

    Article  PubMed  Google Scholar 

  8. Befeler AS, Palmer DE, Hoffman M, et al. The safety of intra-abdominal surgery in patients with cirrhosis: model for end-stage liver disease score is superior to Child-Turcotte-Pugh classification in predicting outcome. Arch Surg. 2005;140:650–4.

    Article  PubMed  Google Scholar 

  9. Northup PG, Wanamaker RC, Lee VD, et al. Model for end-stage liver disease (MELD) predicts nontransplant surgical mortality in patients with cirrhosis. Ann Surg. 2005;242(2):244–51.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Teh SH, Nagorney DM, Stevens SR, et al. Risk factors for mortality after surgery in patients with cirrhosis. Gastroenterology. 2007;132:1261–9.

    Article  PubMed  Google Scholar 

  11. Telem DA, Schiano T, Goldstone R, Han DK, Buch KE, Chin EH, Nguyen SQ, Divino CM. Factors that predict outcome of abdominal operations in patients with advanced cirrhosis. Clin Gastroenterol Hepatol. 2010;8:451–7.

    Article  PubMed  Google Scholar 

  12. Kiamanesh D, Rumley J, Moitra VK. Monitoring and managing hepatic disease in anaesthesia. Br J Anaesth. 2013;111 Suppl 1:i50–61.

    Article  PubMed  Google Scholar 

  13. Curro G, Lapichino G, Melita G, et al. Laparoscopic cholecystectomy in Child-Pugh class C cirrhotic patients. JSLS. 2005;9:311–5.

    PubMed  PubMed Central  Google Scholar 

  14. Azoulay D, Buabse F, Damiano I, et al. Neoadjuvant transjugular intrahepatic portosystemic shunt: a solution for extrahepatic abdominal operation in cirrhotic patients with severe portal hypertension. J Am Coll Surg. 2001;193(1):46–51.

    Article  CAS  PubMed  Google Scholar 

  15. Kim JJ, Narasimham LD, Yu E, Fontana RJ. Cirrhotic patients with a transjugular intrahepatic portosystemic shunt undergoing major extrahepatic surgery. J Clin Gastroenterol. 2009;43(6):574–9.

    Article  PubMed  Google Scholar 

  16. Hoetzel A, Ryan H, Schmidt R. Anesthetic considerations for the patient with liver disease. Curr Opin Anaesthesiol. 2012;25(3):340–7.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Kara J. Mitchell M.D. .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Mitchell, K.J. (2015). Liver Disease and Perioperative Risk. In: Jackson, M.B., Mookherjee, S., Hamlin, N.P. (eds) The Perioperative Medicine Consult Handbook. Springer, Cham. https://doi.org/10.1007/978-3-319-09366-6_16

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-09366-6_16

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-09365-9

  • Online ISBN: 978-3-319-09366-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics