The incidence and outcome of postoperative hepatic encephalopathy in patients with cirrhosis

Zachary M. Saleh, Quintin P. Solano, Jeremy Louissaint, Peter Jepsen, Elliot B. Tapper

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Background: Cirrhosis is associated with increased perioperative risks related to hepatic decompensation. However, data are lacking regarding the incidence and outcomes of postoperative hepatic encephalopathy (HE). Objective: To determine the incidence of HE postoperatively, factors associated with its development, and its association with in-hospital mortality. Methods: Retrospective 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). Results: Overall, 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). Discussion: HE 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.

Original languageEnglish (US)
Pages (from-to)672-680
Number of pages9
JournalUnited European Gastroenterology Journal
Issue number6
StatePublished - Jul 2021
Externally publishedYes


  • HE
  • MELD-na
  • hepatic decompensation
  • hepatic encephalopathy
  • manuscript info section: liver cirrhosis
  • mortality
  • outcome
  • perioperative risk
  • postoperative
  • surgery

ASJC Scopus subject areas

  • Oncology
  • Gastroenterology


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