**3. Risk estimation [10-30]**

The risk of surgery in patients with impairment of liver functions depends on the severity of liver disease, nature of the surgery, and comorbid conditions. Patients with compensated cirrhosis and normal synthetic function have a low risk. The risk increases for patients with decompensated liver cirrhosis. Patients with advanced liver disease may benefit from non‐ surgical therapy when appropriate.

#### **3.1. Contraindications to elective surgery**


Elective surgery should be postponed in patients with abnormal liver tests. All patients should have thorough preoperative evaluation, and their conditions are to be optimized before elective surgery. Elective surgery can be rescheduled or cancelled once the severity of under‐ lying liver disease is assessed.

When surgery is mandatory, meticulous perioperative management is required, including hemodynamic stability, broad-spectrum antibiotics, correction of coagulopathy, improvement of nutritional status, avoidance of nephrotoxins and sedatives that could precipitate hepatic encephalopathy, and intensive care unit admission if needed.
