Friedman et al identified liver diseases that can serve as contraindications for performing elective surgery. Patients with one or more of these conditions is at risk for complications during or after surgery. The author is from Massachusetts General Hospital.


NOTE: The patients may undergo minor, superficial surgical procedures. However, even open liver biopsy may associated with increased complications in these patients.


Acute liver disease:

(1) acute viral hepatitis

(2) acute alcoholic hepatitis

(3) fulminant hepatic failure

(4) moderate to severe alcoholic or nonalcoholic steatohepatitis (> 30% of hepatocytes contain fat)


Chronic liver disease:

(1) severe chronic hepatitis (especially with portal hypertension, impaired hepatic function, or hepatocellular necrosis)

(2) cirrhosis, Child's class C


Severe coagulopathy:

(1) platelet count < 50,000 per µL

(2) prothrombin time > 3 seconds beyond control despite vitamin K administration


Severe extrahepatic complications:

(1) hypoxemia (PaO2 < 60 mm Hg)

(2) acute renal failure

(3) cardiomyopathy and/or heart failure


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