A retrospective analysis was made of 58 patients who unexpectedly developed multiple organ failure (MOF) following elective surgery, and the results were compared with those of 168 control patients who did not develop MOF. In 33 patients with liver cirrhosis, MOF was related to poor liver function, a low albumin level, excessive blood loss, many transfusions, and a high incidence of hypotension. MOF, rather than liver failure alone, was featured by postoperative bleeding and infection. In 15 patients with esophageal carcinoma, MOF was correlated with many transfusions, anastomotic leakage, and postoperative infection. In 10 patients who underwent surgery for an aortic aneurysm, poor renal function and extended anesthesia time were associated with MOF. These results indicate that to prevent MOF following elective surgery, it is important to: (1) Select patients for liver surgery according to their liver function, and minimize the risk of bleeding and infection, (2) avoid too many blood transfusions, and minimize the risk of leakage and infection in esophageal surgery, and (3) select patients for aortic surgery based on renal function and reduce the anesthesia time as much as possible.