Risk of Surgery and Drug Therapy in Patients with Liver Disease

Abstract

Patients with severe or advanced liver diseases have greater risks during surgery than healthy subjects, which must be assessed by hepatologists. Decreases in hepatic blood flow during anesthesia or surgery are associated with postoperative liver damage. The risk of surgery in patients with liver cirrhosis is assessed by the Child–Pugh grade or the Model for End-Stage Liver Disease score. The type of surgery is another factor affecting the risk of patients with liver disease, and cardiac surgery is associated with higher mortality in patients with cirrhosis than other type of operations.

The liver is the main organ of metabolism and elimination of drugs. Thus, decreased liver function may result in abnormally high concentrations of drugs in the body. Drug elimination by the liver could be afftected by the first-pass effect, hepatic metabolism, and biliary extraction, and decreased haptic blood flow or cytochrome P 450 enzyme activities may affect drug metabolism in patients with advanced liver cirrhosis.

Keywords: Cardiac surgery, Child-Pugh (C-P) grade, dosage adjustment of drug, first-pass effect of drug, liver cirrhosis, liver disease, Model for End-Stage Liver Disease (MELD) score, risk assessment, surgery.