Key result
Between 2005 and 2014, the rate of major surgeries significantly decreased from 54.5 to 42.0 per 1,000 cirrhosis admissions (β=-1.454, P<0.001), despite an overall increase in cirrhosis hospitalizations.
Why the study?
Patients with cirrhosis have increased perioperative risk, yet data quantifying temporal trends in surgical procedures and in-hospital mortality by procedure type, elective status, and cirrhosis compensation were needed.
Cohort (n=4,824,116)
Yes
Effect estimate: β=-1.454
Absolute Event Rate: 42% vs 54.5%
p-value: p=<0.001
Despite increasing cirrhosis hospitalizations, the relative number of surgeries is decreasing, highlighting progressive surgical risk aversion and the need for tailored risk scores.
Declining relative surgical rates in cirrhosis may signal risk aversion; leaves open whether refined selection improves outcomes in elective compensated cases.
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.
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Kristen Tessiatore (2020) conducted a cohort in Cirrhosis (n=4,824,116). Calendar year (temporal trend 2005-2014) vs. 2005 baseline was evaluated on Surgical procedures per 1,000 cirrhosis hospitalizations (β=-1.454, p=<0.001). Between 2005 and 2014, the rate of major surgeries significantly decreased from 54.5 to 42.0 per 1,000 cirrhosis admissions (β=-1.454, P<0.001), despite an overall increase in cirrhosis hospitalizations.
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