Real-world outcomes in patients with cirrhosis undergoing cholecystectomy: a population-based study

BACKGROUND: Patients with cirrhosis face increased surgical risk. This study aimed to characterize real-world perioperative outcomes after cholecystectomy in patients with cirrhosis and identify independent predictors of postoperative liver decompensation events (POLDEs) and mortality. METHODS: This was a population-based, retrospective cohort study that used administrative health data from Ontario, Canada. Patients with cirrhosis who underwent cholecystectomy between January 2009 and December 2018 were included. Perioperative outcomes were described, including POLDEs and mortality. Modified Poisson regression analysis was used to identify independent predictors of POLDEs and 90-day mortality while accounting for clustering at the institutional level. RESULTS: A total of 4769 patients were analyzed. The leading etiology of cirrhosis was metabolic dysfunction-associated steatotic liver disease (66%). Most patients (69%) underwent elective surgery. The mean hospital stay was 3.6 days, with a 13% complication rate. Within 90 days, 27% of patients returned to the emergency department, and 10% of patients required readmission. Moreover, 83 patients (1.7%) experienced POLDEs, and 91 patients (1.9%) died. Higher Model for End-Stage Liver Disease-Sodium scores were associated with both postoperative decompensation and mortality. Independent predictors of POLDEs included older age, alcohol-related cirrhosis, and previous decompensation. The predictors of 90-day mortality included advanced age, comorbidities, emergent surgery, and postoperative decompensation. CONCLUSION: Although early liver-related complications and mortality remain low overall, patients with advanced age, comorbidity, history of decompensation, and emergent surgery have significantly worse outcomes. Moreover, the high rates of emergency visits and readmissions highlight the substantial healthcare utilization in this population.