The Prognosis and Risk Factors for Postoperative Hepatic Dysfunction After Open Ascending Aortic Surgery

The prognosis and risk factors of hepatic dysfunction (HD) after open ascending aortic surgery are not well defined. This study aims to analyze the prognosis and identify the major risk factors for patients with HD after open ascending aortic surgery. A retrospective analysis was conducted on patients who underwent open ascending aortic surgery at Shandong First Medical University Affiliated Shandong Provincial Hospital from June 2019 to June 2021. Perioperative clinical data were analyzed, and postoperative HD was defined based on the peak MELD‐XI value recorded at any time during the first 7 postoperative days. Univariate and multivariate binary logistic regression was used to identify risk factors and develop a predictive model, which was then evaluated with the Receiver Operating Characteristic (ROC) curve and plotted with nomogram. Of the 335 patients, 223 (66.6%) were diagnosed with postoperative HD. HD patients had prolonged ICU and hospital stays and a higher risk of hyperbilirubinemia, liver failure, kidney injury, and other complications. However, HD did not affect in‐hospital mortality. Independent risk factors for postoperative HD included gender ( p = 0.014), BMI ( p = 0.022), aortic cross‐clamp time ( p = 0.007), preoperative HD ( p < 0.001), and intraoperative red blood cell transfusion volume ( p < 0.001). The area under the curve (AUC) was 0.803 ( p < 0.001, 95% CI: 0.754–0.851), with a sensitivity of 74.4% and a specificity of 75.9%. The MELD‐XI score is a reliable tool for diagnosing HD after open ascending aortic surgery, particularly for patients on warfarin postoperatively. Postoperative HD following open ascending aortic surgery is common and associated with worse outcomes, although it does not affect in‐hospital mortality. The identified risk factors and predictive model provide a valuable tool for prevention and management of postoperative HD. Larger studies are needed for further validation in the future.