13. Preoperative Evaluation of the Patient with Liver Disease

  1. Eugene R. Schiff MD, MACP, FRCP3,
  2. Willis C. Maddrey MD, MACP, FRCP4 and
  3. Michael F. Sorrell MD, FACP5
  1. Lawrence S. Friedman MD1,2

Published Online: 31 OCT 2011

DOI: 10.1002/9781119950509.ch13

Schiff's Diseases of the Liver, Eleventh Edition

Schiff's Diseases of the Liver, Eleventh Edition

How to Cite

Friedman, L. S. (2011) Preoperative Evaluation of the Patient with Liver Disease, in Schiff's Diseases of the Liver, Eleventh Edition (eds E. R. Schiff, W. C. Maddrey and M. F. Sorrell), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781119950509.ch13

Editor Information

  1. 3

    Center for Liver Diseases and Schiff Liver Institute, University of Miami Miller School of Medicine, Miami, FL, USA

  2. 4

    Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA

  3. 5

    University of Nebraska College of Medicine, Omaha, NE, USA

Author Information

  1. 1

    Department of Medicine, Newton-Wellesley Hospital, Newton, MA, USA

  2. 2

    Harvard Medical School, Tufts University School of Medicine, Boston, MA, USA

Publication History

  1. Published Online: 31 OCT 2011
  2. Published Print: 9 DEC 2011

ISBN Information

Print ISBN: 9780470654682

Online ISBN: 9781119950509

SEARCH

Keywords:

  • Child–Turcotte–Pugh score;
  • Child–Pugh class;
  • cirrhosis;
  • hepatic resection;
  • liver disease;
  • MELD score;
  • model for end-stage liver disease score;
  • surgery

Summary

Elective surgery is performed in patients with liver disease more frequently now than in the past, in part because of the long-term survival of patients with cirrhosis since the advent of liver transplantation. The diseased liver is susceptible to hemodynamic and hypoxic insults that occur with anesthesia and surgery and that may precipitate hepatic decompensation. Therefore, estimation of preoperative risk and careful preoperative preparation are critical in patients with liver disease. In general, surgery is contraindicated in patients with acute hepatitis, acute liver failure, and alcoholic hepatitis. In patients with cirrhosis, rates of surgical mortality and morbidity correlate with the Child–Pugh class and the model for end-stage liver disease (MELD) score; in fact, mortality increases linearly with the MELD score. Additional preoperative considerations are required in patients undergoing biliary tract surgery, cardiac surgery, and hepatic resection. Careful preoperative preparation and postoperative monitoring are essential in any patient with liver disease who undergoes surgery.