What does this research mean for the field?

Pre-existing cirrhosis in patients undergoing hepatectomy for hepatocellular carcinoma independently increases the 30-day risk of major bleeding and transfusion, but does not significantly affect the risk of thrombotic events or short-term mortality. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This study aims to determine if preexisting cirrhosis increases 30-day bleeding and thrombotic complications after hepatectomy.

May 20, 2026

B54-17 Preexisting Cirrhosis and Post-hepatectomy Bleeding, Transfusion, and Pulmonary Embolism: Implications for Perioperative Critical Care

Key Points

This study aims to determine if preexisting cirrhosis increases 30-day bleeding and thrombotic complications after hepatectomy.
Conducted a multicenter, propensity-matched study using the TriNetX Research Network.
Identified adults with incident HCC who underwent hepatectomy and formed matched cohorts (n = 421 per group).
Measured 30-day outcomes for bleeding, transfusion, DIC, DVT, PE, thrombocytopenia, and mortality.
30-day major bleeding was higher in cirrhotic patients (5.82%) compared to non-cirrhotics (2.77%, HR 0.47, 95% CI 0.23-0.97; p = 0.036).
Transfusion rates were also higher in cirrhotic patients (8.43% vs 4.17%, HR 0.49, 95% CI 0.27-0.87; p = 0.012).
Thrombotic events such as DVT and PE were similar between groups, suggesting no significant difference in these risks.

Abstract

Abstract Background Cirrhosis is common among patients undergoing hepatectomy for HCC and heightens ICU concerns regarding coagulopathy and thrombocytopenia during resuscitation, transfusion stewardship, and VTE prophylaxis. To determine whether preexisting cirrhosis independently increases 30-day bleeding and thrombotic complications after hepatectomy, we conducted a multicenter, propensity-matched real-world study.Methods Using the TriNetX Research Network, we identified adults with incident HCC who underwent hepatectomy and compared those with documented cirrhosis versus those without cirrhosis prior to surgery. Propensity scores balanced demographics, comorbidities, and labs to form 1:1 matched cohorts (n = 421 per group). The prespecified 30-day outcomes were major bleeding, transfusion, disseminated intravascular coagulation (DIC), deep vein thrombosis (DVT), pulmonary embolism (PE), thrombocytopenia, and all-cause mortality. We estimated risks, risk differences/ratios, and constructed Kaplan-Meier curves with log-rank tests and Cox models. P-values 0.05 were considered significant; values reported as 0.000 were recorded as 0.001. All values are rounded to two decimals. Results After propensity score matching, 421 patients per cohort had comparable 30-day follow-up. The 30-day Kaplan-Meier cumulative incidence of major bleeding was lower without cirrhosis than with cirrhosis (2.77% 11/397 vs 5.82% 22/378; HR 0.47, 95% CI 0.23-0.97; p = 0.036), and transfusion was likewise less frequent in the non-cirrhosis cohort (4.17% 17/408 vs 8.43% 35/415; HR 0.49, 95% CI 0.27-0.87; p = 0.012). Thrombocytopenia showed a nonsignificant trend toward lower risk without cirrhosis (5.21% 20/384 vs 8.40% 30/357; HR 0.61, 95% CI 0.35-1.08; p = 0.083), while venous thromboembolism outcomes were similar between groups: DVT 2.49% (10/401) vs 2.45% (10/408; HR 0.81, 95% CI 0.32-2.06; p = 0.660) and PE 2.45% (10/408) vs 2.42% (10/414; HR 3.05, 95% CI 0.62-15.13; p = 0.150). DIC rates were identical at 2.38% in each cohort (10/420 vs 10/421; HR 0.50, 95% CI 0.05-5.54; p = 0.566), and 30-day mortality was low and comparable (2.48% 10/403 vs 3.17% 13/410; HR 0.71, 95% CI 0.30-1.65; p = 0.675). Conclusion In propensity-matched hepatectomy cohorts, pre-existing cirrhosis was associated with higher 30-day risks and hazards of transfusion and major bleeding, while thrombotic events (DVT/PE), DIC, and short-term mortality were similar between groups. These data highlight the need for targeted perioperative hemostatic strategies for cirrhotic patients undergoing resection and suggest focused vigilance for bleeding and transfusion within the first postoperative month. This abstract is funded by: None

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