Abstract: BackgroundCirrhosis is associated with increased perioperative risks related to hepatic decompensation. However, data are lacking regarding the incidence and outcomes of postoperative hepatic encephalopathy (HE).ObjectiveTo determine the incidence of HE postoperatively, factors associated with its development, and its association with in‐hospital mortality.MethodsRetrospective cohort study of 583 patients with cirrhosis undergoing non‐hepatic surgery over a 10‐year period. Outcomes included postoperative HE and in‐hospital mortality and were, respectively, evaluated using multi‐state modeling and Fine‐Gray competing risk regression (with postoperative HE as a time‐varying covariate).ResultsOverall, the median Model for End‐Stage Liver Disease Sodium was 10, 61.7% had a history of ascites, 49.9% esophageal varices, and 34.6% HE. The most common surgeries including abdominal/non‐bowel (33.3%), orthopedic (18.0%), and bowel (12.2%). A total of 42 (7.2%) patients developed HE postoperatively during admission. The cumulative risk of HE was 7.2%, which was most associated with a history of HE, ASA class, postoperative AKI, and postoperative infection. In‐hospital mortality occurred in 34 (5.8%) individuals. Only ASA class was independently associated (HR 2.46, 95%CI 1.21–5.02), but there was a trend for postoperative HE (HR 1.71, 95%CI 0.73–3.98).DiscussionHE is an uncommon but not rare postoperative complication that increases the risk of patient harm. This study implies its development is predictable. Consequently, at‐risk patients should have consultation with a hepatologist before undergoing elective surgery. ; Peer Reviewed ; http://deepblue.lib.umich.edu/bitstream/2027.42/168472/1/ueg212104_am.pdf ; http://deepblue.lib.umich.edu/bitstream/2027.42/168472/2/ueg212104.pdf
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