Impact of Liver Cirrhosis on Perioperative Outcomes Among Elderly Patients Undergoing Hepatectomy: the Effect of Minimally Invasive Surgery

  • Kota Sahara
  • Anghela Z. Paredes
  • Diamantis I. Tsilimigras
  • J. Madison Hyer
  • Katiuscha Merath
  • Lu Wu
  • Rittal Mehta
  • Eliza W. Beal
  • Susan White
  • Itaru Endo
  • Timothy M. PawlikEmail author
Original Article



The impact of cirrhosis on perioperative outcomes for elderly patients undergoing hepatectomy remains not well defined. We sought to determine the influence of underlying cirrhosis and minimally invasive surgery (MIS) on postoperative outcomes among elderly patients who underwent a hepatectomy.


Patients who underwent hepatectomy between 2013 and 2015 were identified using the Center for Medicare Services (CMS) 100% Limited Data Set (LDS) Standard Analytic Files (SAFs). Short-term outcomes after hepatectomy, stratified by the presence of cirrhosis and MIS, were examined.


Among 7452 patients who underwent a hepatectomy, a minority had cirrhosis (n = 481, 6.5%) whereas the vast majority did not (n = 6971, 93.5%). Overall, median patient age was 72 years (IQR 68–76) and preoperative Charlson comorbidity score was 6 (IQR 2–8). Patients with cirrhosis were more likely to be younger (median age 71 [67–76] vs 72 [IQR 68–76] years), male (64.4% vs 50%), African American (8.1% vs 6.4%) and have a malignant diagnosis (87.1% vs 78.7%) compared to non-cirrhotic patients (all p < 0.001). There was no difference among patients with and without cirrhosis regarding type of hepatectomy or surgical approach (open vs MIS) (both p > 0.05). Patients with versus without cirrhosis had similar complication rates (24.1% vs 22.3%, p = 0.36), as well as 30-day (6.2% vs 5%, p = 0.25) and 90-day (10.4% vs 8.5%, p = 0.15) mortality. MIS reduced the length-of-stay in non-cirrhotic patients (OR 0.79, 95% CI 0.62–0.99, p < 0.05), yet was not associated with morbidity or mortality (both p > 0.05).


The presence of cirrhosis did not generally impact outcomes in elderly patients undergoing hepatectomy for benign and malignant diseases. MIS hepatectomy in the elderly Medicare beneficiary population reduced LOS among patients without cirrhosis, yet was not associated with differences in morbidity or mortality.


Cirrhosis Elderly Hepatectomy Outcomes 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Supplementary material

11605_2019_4117_MOESM1_ESM.docx (17 kb)
ESM 1 (DOCX 16 kb)


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Copyright information

© The Society for Surgery of the Alimentary Tract 2019

Authors and Affiliations

  • Kota Sahara
    • 1
    • 2
  • Anghela Z. Paredes
    • 1
  • Diamantis I. Tsilimigras
    • 1
  • J. Madison Hyer
    • 1
  • Katiuscha Merath
    • 1
  • Lu Wu
    • 1
  • Rittal Mehta
    • 1
  • Eliza W. Beal
    • 1
  • Susan White
    • 3
  • Itaru Endo
    • 2
  • Timothy M. Pawlik
    • 1
    • 4
    Email author
  1. 1.Division of Surgical OncologyThe Ohio State University Wexner Medical Center and James Comprehensive Cancer CenterColumbusUSA
  2. 2.Gastroenterological Surgery DivisionYokohama City University School of MedicineYokohamaJapan
  3. 3.Division of Health Information Management and Systems, The Ohio State Wexner Medical CenterThe Ohio State UniversityColumbusUSA
  4. 4.Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer ResearchThe Ohio State University, Wexner Medical CenterColumbusUSA

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