Surgery · 2026
Association of decompensated cirrhosis with acute clinical and financial outcomes following cardiac operations.
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Ali Konmal, Desai Kruti, Rahmani Jaden, Ali Syed Shaheer, Lai Owen, Mehta Deep, Justo Melissa, Benharash Peyman
Аннотация
BACKGROUND: Patients with cirrhosis undergoing cardiac surgery comprise a high-risk population. Despite advances in surgical care, traditional risk models often underestimate risk in this cohort. We used a nationally representative sample to assess the association of cirrhosis with in-hospital mortality, postoperative complications, and resource utilization.
METHODS: All elective adult (≥18 years) hospitalizations for coronary, valvular, and proximal aortic operations were tabulated from the 2016 to 2022 Nationwide Readmissions Database. Multivariable regression models were developed to assess the association of cirrhosis with outcomes of interest. Those with advanced or decompensated cirrhosis, defined by the presence of ascites, esophageal varices, or encephalopathy, were classified as patients with cirrhosis. To retain cohort homogeneity, records involving heart transplantation, ventricular assist device placement, or endocarditis were not considered.
RESULTS: Of 1,042,779 records, 16,111 (1.6%) had cirrhosis. Patients with cirrhosis were more commonly female (37.0 vs 28.9%; P < .001), had a higher median Elixhauser Index (7 [6-9] vs 5 [3-6]; P < .001), and were more likely classified in the lowest income quartile (26.7 vs 24.1%; P < .001). Following risk adjustment, cirrhosis was associated with increased odds of mortality (adjusted odds ratio, 8.96; 95% confidence interval, 8.21-9.79). In addition, cirrhosis was associated with greater odds of cardiac (adjusted odds ratio, 1.99; 95% confidence interval, 1.90-2.11), infectious (adjusted odds ratio, 2.15; 95% confidence interval, 2.01-2.31), and renal (adjusted odds ratio, 2.87; 95% confidence interval, 2.71-3.04) complications.
CONCLUSION: Decompensated cirrhosis was found to be associated with inferior survival, greater postoperative complications, higher costs, and prolonged length of stay. Future work should optimize risk stratification to better inform shared decision-making and choice of alternative therapies.
METHODS: All elective adult (≥18 years) hospitalizations for coronary, valvular, and proximal aortic operations were tabulated from the 2016 to 2022 Nationwide Readmissions Database. Multivariable regression models were developed to assess the association of cirrhosis with outcomes of interest. Those with advanced or decompensated cirrhosis, defined by the presence of ascites, esophageal varices, or encephalopathy, were classified as patients with cirrhosis. To retain cohort homogeneity, records involving heart transplantation, ventricular assist device placement, or endocarditis were not considered.
RESULTS: Of 1,042,779 records, 16,111 (1.6%) had cirrhosis. Patients with cirrhosis were more commonly female (37.0 vs 28.9%; P < .001), had a higher median Elixhauser Index (7 [6-9] vs 5 [3-6]; P < .001), and were more likely classified in the lowest income quartile (26.7 vs 24.1%; P < .001). Following risk adjustment, cirrhosis was associated with increased odds of mortality (adjusted odds ratio, 8.96; 95% confidence interval, 8.21-9.79). In addition, cirrhosis was associated with greater odds of cardiac (adjusted odds ratio, 1.99; 95% confidence interval, 1.90-2.11), infectious (adjusted odds ratio, 2.15; 95% confidence interval, 2.01-2.31), and renal (adjusted odds ratio, 2.87; 95% confidence interval, 2.71-3.04) complications.
CONCLUSION: Decompensated cirrhosis was found to be associated with inferior survival, greater postoperative complications, higher costs, and prolonged length of stay. Future work should optimize risk stratification to better inform shared decision-making and choice of alternative therapies.