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 post-operative mortality in a large VA dataset. 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 post-operative mortality through 90 days versus 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.