High Cirrhosis Surgical Volume Centers Have Reduced Postoperative Mortality in Patients With Cirrhosis Undergoing...

Area of Science:

• Hepatology
• Surgical Outcomes
• Health Services Research

Background:

• Patients with cirrhosis have elevated surgical risks and require specialized care.
• Center surgical volume is a potential factor influencing outcomes in this population.

Purpose of the Study:

• To investigate the association between hospital surgical volume for cirrhosis patients and postoperative mortality.
• To determine if higher surgical volumes at centers correlate with better patient outcomes.

Main Methods:

• Retrospective cohort study utilizing a large Veterans Affairs (VA) dataset.
• Analysis of 14,500 major surgeries performed on patients diagnosed with cirrhosis.
• Adjusted analysis comparing postoperative mortality rates between high-volume and low-volume centers.

Main Results:

• High-volume centers (performing >16 cirrhosis surgeries annually) demonstrated a 36% reduced hazard of 90-day postoperative mortality compared to low-volume centers (<9 surgeries annually).
• The hazard ratio for postoperative mortality was 0.64 (95% CI 0.43-0.94, P=0.02) favoring high-volume centers.
• Findings indicate a significant survival benefit for cirrhosis patients undergoing major surgery at centers with higher procedural experience.

Conclusions:

• Center surgical volume is a critical factor in mitigating postoperative mortality for patients with cirrhosis.
• Triage of cirrhosis patients to high-volume centers for major surgery, when feasible, is recommended to improve outcomes.
• This study underscores the importance of healthcare system organization and specialization in managing complex surgical patients.