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

Patients with cirrhosis have increased surgical risk and require care team expertise. We explored the association between center cirrhosis surgical volume and postoperative mortality in a large VA data set. In this retrospective cohort study of 14,500 major surgeries in patients with cirrhosis, we found in adjusted analysis that high-volume centers (>16 surgeries in past year) had a 36% reduced hazard of postoperative mortality through 90 days vs low-volume centers (<9 surgeries in past year; hazard ratio 0.64, 95% confidence interval 0.43-0.94, P = 0.02). These findings demonstrate the importance of triaging patients with cirrhosis to high-volume centers for major surgery when feasible.