ArticleHepatology (Baltimore, Md.)2021
Risk Prediction Models for Post-Operative Mortality in Patients With Cirrhosis.
Article in Hepatology (Baltimore, Md.), 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 89 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
89 citing papers in PubMed, 1 synthesis or guideline pooled it, 166 citations in OpenAlex.
- Predictive value of neutrophil to lymphocyte ratio for clinical outcomes in liver cirrhosis: A systematic review and meta-analysis.PloS one · 2025Pooled it
- Bone metastases from hepatocellular carcinoma: Guidance on the management of spinal and long bone lesions.Journal of bone oncology · 2026Review
- Cardiac Surgery Management in Patients With Liver Cirrhosis.Reviews in cardiovascular medicine · 2026Review
- Blood circulating C228T TERT gene promoter mutation is an independent factor for the prognosis of HBV-related hepatocellular carcinoma.BMC cancer · 2026Article
- Validation of current mortality risk prediction models in patients with cirrhosis undergoing cardiac surgery.JTCVS open · 2026Article
- The diagnosis and management of portal hypertension in cirrhosis: The Gastroenterological Society of Australia consensus.Hepatology communications · 2026Article
- Management of Liver Cirrhosis in Percutaneous and Surgical Cardiac Interventions.Journal of the American Heart Association · 2026Review
- The ATP7B c.3316 G > A variant is associated with mild subphenotype in Wilson disease: a single-center cohort study.Orphanet journal of rare diseases · 2026Article
- Gut microbiota and postoperative delirium: mechanistic integration of the "gut-liver-anesthesia axis" in the context of liver disease and perioperative intervention strategies.Frontiers in medicine · 2026Review
- Impact of Surgery Duration on Postoperative Mortality in Patients With Cirrhosis.Gastro hep advances · 2026Article
- Neoadjuvant Under-Dilated TIPS: Expanding Surgeries for Extrahepatic Malignancies in Patients With Cirrhosis and CSPH.Liver international : official journal of the International Association for the Study of the Liver · 2026Article
- Five essential features for adoption of clinical risk prediction tools: Insights from the VOCAL-Penn score.Hepatology communications · 2025Article
- [Analysis of the impact of tumor diameter on short-term prognosis in patients with hepatitis B-related hepatocellular carcinoma-inducing acute-on-chronic liver failure].Zhonghua gan zang bing za zhi = Zhonghua ganzangbing zazhi = Chinese journal of hepatology · 2025Article
- Acute-on-chronic liver failure.BJA education · 2025Review
- Transjugular diagnostic procedures in hepatology: Indications, techniques and interpretation.JHEP reports : innovation in hepatology · 2025Review
- Complication profiles after total hip arthroplasty in non-cirrhotic NAFLD versus cirrhotic patients: A national matched cohort comparison.Journal of orthopaedics · 2025Article
- Trends in surgical volume and mortality by surgery type among patients with cirrhosis: A Veterans Affairs study.Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society · 2025Article
- Optimized machine learning mechanism for big data healthcare system to predict disease risk factor.Scientific reports · 2025Article
- The association between cirrhosis and outcomes among female patients undergoing surgery for breast cancer in Ontario: a population-based study.Breast cancer research and treatment · 2025Article
- The clinical relevance of acute-on-chronic liver failure in medical procedures: Endoscopy, interventions and surgery.Liver international : official journal of the International Association for the Study of the Liver · 2025Review
29 more citing papers are in PubMed but not listed here.
Corrections and comments
- Commented on by
- Commented on by
Authors and funding
10 authors at 6 institutions in 1 country.
Funding
Abstract
BACKGROUND AND
aimsPatients with cirrhosis are at increased risk of postoperative mortality. Currently available tools to predict postoperative risk are suboptimally calibrated and do not account for surgery type. Our objective was to use population-level data to derive and internally validate cirrhosis surgical risk models. APPROACH AND
resultsWe conducted a retrospective cohort study using data from the Veterans Outcomes and Costs Associated with Liver Disease (VOCAL) cohort, which contains granular data on patients with cirrhosis from 128 U.S. medical centers, merged with the Veterans Affairs Surgical Quality Improvement Program (VASQIP) to identify surgical procedures. We categorized surgeries as abdominal wall, vascular, abdominal, cardiac, chest, or orthopedic and used multivariable logistic regression to model 30-, 90-, and 180-day postoperative mortality (VOCAL-Penn models). We compared model discrimination and calibration of VOCAL-Penn to the Mayo Risk Score (MRS), Model for End-Stage Liver Disease (MELD), Model for End-Stage Liver Disease-Sodium MELD-Na, and Child-Turcotte-Pugh (CTP) scores. We identified 4,712 surgical procedures in 3,785 patients with cirrhosis. The VOCAL-Penn models were derived and internally validated with excellent discrimination (30-day postoperative mortality C-statistic = 0.859; 95% confidence interval [CI], 0.809-0.909). Predictors included age, preoperative albumin, platelet count, bilirubin, surgery category, emergency indication, fatty liver disease, American Society of Anesthesiologists classification, and obesity. Model performance was superior to MELD, MELD-Na, CTP, and MRS at all time points (e.g., 30-day postoperative mortality C-statistic for MRS = 0.766; 95% CI, 0.676-0.855) in terms of discrimination and calibration.
conclusionsThe VOCAL-Penn models substantially improve postoperative mortality predictions in patients with cirrhosis. These models may be applied in practice to improve preoperative risk stratification and optimize patient selection for surgical procedures (www.vocalpennscore.com).
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.