Perioperative management of liver disease

From IDWiki

Risk Assessment

  • Perioperative mortality increases with MELD score and Child-Pugh class
    • Mortality has improved over the years, though
  • Mortality increases linearly and continuously with MELD score
    • MELD score <8: 6% mortality
    • MELD score >20: 50% mortality
  • Child-Pugh class
    • Old data suggested mortalities of 10%, 30%, and 80% for classes A, B, and C
    • Newer data suggests mortalities may have decreased to 10%, 20%, and 60%

Recommended Cutoffs

Procedure Recommended cutoffs
All surgeries Surgery generally contraindicated in Child-Pugh C and MELD >20; risk is proportional to MELD
CABG MELD <13.5
Bariatric surgery Child-Pugh A
Lung cancer Child-Pugh A
Colon resection MELD <9
Lumbar spine surgery Child-Turcotte-Pugh <6
Head-and-neck cancer surgery Child-Pugh A, MELD <10

Management

  • Transfuse platelets to target >50
  • No role for fresh frozen plasma (FFP), though it is often done
  • No role for prothrombin complex concentrate (Octaplex)
  • Ignore the INR

Further Reading