Monday, February 14, 2011

Surgical risk in patients with liver disease

In evaluating patients with cardiac disease for non-cardiac surgery we've gotten away from “clearing” patients. There just aren't that many contraindications to elective surgery, and when present they're pretty obvious: critical aortic stenosis, recent unstable coronary syndromes, uncontrolled arrhythmias and decompensated heart failure.

In the case of liver disease it gets a little more tricky, because there are several contraindications you might not be used to thinking about. Transactions of the American Clinical and Climatological Association, one of the best kept secrets among medical journals by the way, has recently published an excellent review on the topic. It's available as open access full text, so go read it in the original, but here are some spoilers. There's a list of well known contraindications. Know them. Absent such a specific contraindication, if the patient has stable cirrhosis, do a Child or a MELD.

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