S1726 Trends in Surgical Volume and Procedure Type Among Patients with Cirrhosis: A Veterans Affairs Study

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Introduction: Cirrhosis is associated with increased perioperative risk, yet cirrhosis itself may also potentially increase the need for surgical procedures. Furthermore, the population of elderly patients with cirrhosis in the United States has increased over time, which may confer additional risk in this population. We sought to quantify trends in surgical volume, procedure type, and median patient age over time. Methods: This was a retrospective cohort study of Veterans Health Administration patients with cirrhosis who underwent surgical procedures from 1/2008-12/2021. Surgeries were categorized as chest, cardiac, abdominal, abdominal wall, rectum/genitourinary/retroperitoneal, vascular, minor orthopedic, major orthopedic, spine, or Central nervous system. Results: The cohort included 15,589 patients with median age 65 years. 97.1% were male and 63.1% were White. Alcohol was the most common etiology of liver disease, comprising 32.7% of patients. Over time, both surgical volume and median patient increased, and these were closely correlated (r=0.88, P=0.009). The proportion of major abdominal and cardiac surgeries decreased somewhat over time, while the proportion of major and minor orthopedic surgeries increased. Conclusion: As cohorts of patients with cirrhosis age, the volume of surgical procedures performed in patients with cirrhosis may continue to increase. Whereas major abdominal surgeries once comprised the majority of procedures, major orthopedic surgeries are now the most common procedure. This may reflect evolving tolerance of risk in an aging cohort, as well as increased availability of non-invasive options that may help avoid major abdominal surgeries (see Figure 1).Figure 1.: A) Trends in annual surgical volume and median patient age by year; B) Relative proportion of surgery types by year.

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