Patients with liver disease who require surgery are at greater risk for surgical and anesthesia related complications than those with a healthy liver [1-5]. The magnitude of the risk depends upon the type of liver disease and its severity, the surgical procedure, and the type of anesthesia.
The assessment of surgical risk in patients with liver disease will be reviewed here. Patients with liver disease may have concomitant disorders (such as cardiovascular disease) that influence surgical outcomes; these issues are discussed separately. (See "Preoperative medical evaluation of the healthy patient" and "Estimation of cardiac risk prior to noncardiac surgery".)
SCREENING FOR LIVER DISEASE BEFORE SURGERY
Patients undergoing surgery should undergo a history and physical examination to exclude findings of or risk factors for liver disease. This may include asking about prior blood transfusions, tattoos, illicit drug use, sexual promiscuity, a family history of jaundice or liver disease, a history of jaundice or fever following anesthesia, alcohol use (current, prior and quantity), and a complete review of current medications. Clinical features suggestive of liver disease (such as fatigue, pruritus, increased abdominal girth, jaundice, palmar erythema, spider telangiectasias, splenomegaly, and gynecomastia and testicular atrophy in men) should be evaluated.
Whether otherwise healthy surgical candidates should undergo biochemical screening for liver disease is controversial. The vast majority of patients found to have abnormal liver biochemical test results do not have advanced liver disease. Thus, it is unlikely that routinely obtaining a liver biochemical profile in otherwise healthy patients without risk factors for liver disease would lead to improved outcomes; thus, such testing is not recommended. (See "Preoperative medical evaluation of the healthy patient".)
EFFECTS OF ANESTHESIA AND SURGERY ON THE LIVER
The effects of anesthesia and surgery on the liver depend upon the type of anesthesia used, the specific surgical procedures, and the severity of liver disease. In addition, perioperative events, such as hypotension, sepsis, or the administration of hepatotoxic drugs, can compound injury to the liver occurring during the procedure. (See "Effects of anesthesia and surgery on the liver".)