Postoperative jaundice

Abstract

The postoperative development of jaundice can be a distressing complication of an otherwise uneventful surgical procedure. It has been estimated that approximately 1 per cent of all surgical patients develop clinically significant jaundice after general anesthesia. Under certain conditions, such as open heart surgery or splenorenal shunts for portal hypertension, the incidence of postoperative jaundice is significantly higher. Jaundice, that is, the accumulation of bilirubin, can be categorized according to three broad pathophysiologic mechanisms: increased pigment load to the liver, postoperative impaired hepatocellular function, and extrahepatic obstruction. Many different factors may work in concert to contribute to the development of jaundice, particularly in elderly patients with cardiovascular, renal, and hematopoietic functional impairment. Prolonged hypotension, hypoxia, and cardiac failure - all common situations during or after a major surgical procedure - can initiate multisystem organ failure, including postoperative jaundice. A practical and orderly approach is needed in these patients in diagnosing the cause of postoperative jaundice. If the underlying disorder is corrected, the jaundice will subside spontaneously. Only rarely does the postoperative development of jaundice necessitate invasive testing, repeat surgery, or specific pharmacologic treatment.