16 de setembro de 2011

Artigo recomendado: Assessing the risk of surgery in patients with liver disease


Amitabh Suman, MD, William D. Carey, MD

Cleveland Clinic Journal of Medicine V.73 n.4 April 2006

ABSTRACT
Recent studies have defined objective criteria for determining whether surgery is safe for patients with liver disease. Using these criteria, we may extend the benefit of surgery to more patients with liver disease without increasing the risk.

KEY POINTS
  • Patients with liver disease are at higher risk of death and hepatic decompensation if they undergo surgery than people without liver disease.
  • Liver disease is often undiagnosed before surgery unless it is specifically looked for.
  • Liver disease does not exclude surgery; certain types of surgery can be undertaken safely if patients are chosen carefully.
  • A recent study has suggested a Child-Pugh score of 8 and a Model for End-Stage Liver Disease (MELD) score of 14 as the cutoff values above which surgery poses too much risk for patients with cirrhosis.
  • Surgery is usually not advisable in patients with acute hepatitis, but it appears safe in mild chronic hepatitis.
Because Liver Disease is common, many patients undergoing surgery have it. Patients with liver disease face a higher risk of surgical complications, including death from surgery and anesthesia, but the level of risk is hard to assess because all liver disease is not the same, and neither is all surgery. Uncertainty has led some physicians to be reluctant to send any patient with liver disease to surgery, and others to take unjustified risks.

Although risk assessment has often been based on anecdote, a number of studies can provide guidance in this respect. The goal is to avoid surgery in patients at high risk without denying the benefits of surgery to those at reasonable risk. This review provides the clinician an up-to-date guide to risk assessment for anesthesia and surgery in patients with liver disease.

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