Unexpected hepatic dysfunction found by multiple laboratory screening

During a 1-year period, 7620 elective surgical admissions were given multiple laboratory screening (SMA-18) determinations. Of these, 11 healthy patients, aged 10 to 54, with a pretest classification of ASA 1 (no systemic disease) were found to have clearly abnormal elevations of the SGOT, SGPT, and LDH levels. The proposed elective surgical procedures and anesthesia were canceled. All 11 patients proved to have overt liver pathology by further testing, and 3 later became clinically jaundiced. No cases of unexplained postsurgical jaundice occurred in any of the other 7609 operated cases during the 1-year study. The incidence of clearly elevated enzyme levels in voluntary hospital surgical admissions is approximately 1/700 and the incidence of clinical jaundice is approximately 1/2540. There appears to be a seasonal variation, with the preponderance of elevated enzyme levels in the winter and spring months.