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. 2021;34(1):85-92.
doi: 10.20524/aog.2020.0554. Epub 2020 Nov 20.

Trends in surgical volume and in-hospital mortality among United States cirrhosis hospitalizations

Kristen M Tessiatore  1 , Nadim Mahmud  2   3
Affiliations

Trends in surgical volume and in-hospital mortality among United States cirrhosis hospitalizations

Kristen M Tessiatore et al. Ann Gastroenterol. 2021.

Abstract

Background: In the aging population of patients with cirrhosis in the United States, there is a potentially increased need for surgical procedures. However, individuals with cirrhosis have increased perioperative risk relative to patients without cirrhosis. We sought to quantify temporal trends in cirrhosis surgical procedures and in-hospital mortality in relation to surgical procedure type, elective admission status and compensated vs. decompensated status.

Methods: We performed a retrospective cohort study of cirrhosis hospitalizations between 2005 and 2014 using the National Inpatient Sample. Surgical procedures of interest included cholecystectomy, hernia repair, and major abdominal, orthopedic and cardiovascular surgery. We plotted trends in volume and in-hospital mortality by procedure type, and used linear regression to test the significance of trends.

Results: While the number of cirrhosis hospitalizations increased over time, the number of surgeries per 1000 admissions decreased (b=-1.454, P<0.001). When stratified by elective admission status, elective major orthopedic surgeries significantly increased over time (b=177.9; P<0.001). In-hospital mortality rates for most surgeries were significantly higher in the non-elective vs. elective setting (each P<0.001). In patients with compensated cirrhosis, there was a significant increase in the number of orthopedic (b=272.4; P<0.001) and hernia repair surgeries over time (b=191.1; P<0.001). Overall, there was significantly greater in-hospital mortality among patients with decompensated cirrhosis (each P<0.05). Q. Please mention the exact P-value unless <0.001.

Conclusions: Despite an increasing number of cirrhosis hospitalizations, the decreasing relative number of cirrhosis surgeries may indicate progressive surgical risk aversion. Future cirrhosis surgical risk scores should consider surgical procedure type, elective/non-elective status, and decompensation status.

Keywords: Liver disease; admission; decompensation; elective; outcomes; procedures.

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Conflict of interest statement

Conflict of Interest: None

Figures

Figure 1
Figure 1
(A, B) National trends in cirrhosis surgery admissions by overall volume (A) and per 1000 cirrhosis admissions (B)
Figure 2
Figure 2
National trends in cirrhosis surgery admissions (A) and associated in-hospital mortality rates (B), each stratified by elective or non-elective admission status
Figure 3
Figure 3
National trends in cirrhosis surgery admissions (A) and associated in-hospital mortality rates (B), each stratified by compensated or decompensated cirrhosis status
See this image and copyright information in PMC

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