Liver stiffness as pre-operative risk parameter for routine abdominal surgery

Aims: Liver cirrhosis is a serious complication risk for routine surgery but no quantitiave screening tools exist. Vibration-controlled transient elastography (VCTE/Fibroscan) is a rapid and non-invasive bed side technique to assess liver stiffness (LS). Since LS is increased by various pathological conditions such as fibrosis, venous pressure, hepatitis and cholestasis that negatively affect the operation risk, VCTE could be an efficient preoperative screening tool for the risk assessment.

Methods: LS was measured in addition to the routine preoperative anesthesia protocol (including ASA score) in 100 patients undergoing abdominal or urological surgery (e.g.cholecystectomy, bowel surgery, nephrectomy). Fibroscan using M or XL probe was performed for LS measurements. In addition, transaminases were obtained and all patients with increased LS were reassessed after complete recovery from surgery.

Results: No specific complications occurred in any of the 100 patients. 19 patients (19%) had increased LS, 9 of them with LS>8 kPa and 3 of them >12.5 kPa (cut-off values for F3 and F4 fibrosis). Reasons for increased LS >12.5 kPa were known liver cirrhosis or mechanic cholestasis due to gallstone disease. In the remaining patients, increased LS could only partly be explained by increased transaminases (n=3). In all 7 follow up patients, LS was decreased, in five of them it completely normalized. Patients with increased LS had slightly elevated ASA (1.83 vs. 2.05).

Conclusions: A rather high proportion of patients undergoing abdominal surgery have increased LS rendering it a potential preoperative risk parameter for abdominal surgery. Studies in a larger cohort of patients with more severe operations are required to determine the use of LS.