Value of Liver Enzymes in Preoperative Assessment

Abstract

Background:Liver function abnormalities may lead to an increase in surgical morbidity and mortality risk. Worldwide, the routine assessment of liver function is not recommended unless there is clinical suspicion of underlying liver disease, based on the patient's history and physical examination findings as this will pick up clinically-significant liver disease.In Egypt most of hospitals and medical centers are performing liver function tests as part of routine preoperative assessment without evidence base and even against international recommendations. Is this a waste of resources or it can be cost effective by decreasing morbidity and mortality? To put in our consideration, we have a heavy burden of chronic liver disease mostly secondary to HCV. Objectives:To evaluate our current practice in performing liver biochemical and function panel as part of routine preoperative assessment. And demonstrate the effect of liver enzyme values on the preoperative decision and outcomes. Methods:466 patients were included from patients admitted to KasrAlainy Hospital general surgical wards for elective surgery in the period from May to October 2014, those patients had no history or physical finding suggesting liver disease, patients underwent routine preoperative tests including ALT, AST, ALP, bilirubin, albumin, CBC and coagulation profile.The collected data was managed by Statistical package for social sciences (SPSS). Results:Among the 466 patients included in the study there were 39 patients with elevation in one or more of the transaminases (8.4%), with significantly higher prevalence among males, patients with manual works and those with low serum albumin. Among those 39 patients with elevated transaminases there was no change or delay in the decision of surgery with no post-operative hepatic complications. Conclusion:We have higher prevalence of elevated liver enzymes among patients scheduled for elective surgery compared to international studies; although this did not change the decision of surgery of affect the outcomes. Keywords:ALT, AST, ALP, HCV, preoperative assessment.