Preoperative Liver Stiffness is Associated With Hospital Length of Stay After Cardiac Surgery

Giancarlo Suffredini, Charlie Slowey, Junfeng Sun, Wei Dong Gao, Chun (Dan) W. Choi, Hamza Aziz, Ahmet Kilic, Stefano Schena, Jennifer Lawton, James Peter Hamilton, Jeffrey M. Dodd-o

Research output: Contribution to journalArticlepeer-review


Objectives: Risk assessment models for cardiac surgery do not account for the degrees of liver dysfunction. Ultrasound shear-wave elastography measures liver stiffness (LSM), a quantitative measurement related to fibrosis, congestion, and inflammation. The authors hypothesized that preoperative liver stiffness would be associated with hospital length of stay after cardiac surgery. Design: Prospective observational study. Setting: University hospital, single center. Participants: One hundred five adult patients undergoing nonemergent cardiac surgery. Interventions: Preoperative liver stiffness measured by ultrasound elastography. Measurements and Main Results: The associations were analyzed using linear mixed models, with adjustments for preoperative variables, duration of cardiopulmonary bypass, and type of surgery. Median liver stiffness was 6.4 kPa (range, 4.1-18.6 kPa). The median length of hospital stay was 6 days (range, 3-18 d). Each unit increase in liver stiffness, treated as a continuous variable, was associated with an increase of 0.32 ± 0.10 days in the hospital (p = 0.002). When treated as a categorical variable (<6 kPa, 6-9.4 kPa, and ≥9.5 kPa), LSM ≥9.5 kPa v LSM <6 kPa was associated strongly with an increase in hospital length of stay of 3.25 ± 0.87 days (p = 0.0003). Conclusions: A preoperative LSM ≥9.5 kPa was associated with a significantly longer postoperative hospital length of stay. This association appeared independent of preoperative comorbidities commonly associated with coronary disease. Preoperative liver stiffness is a novel risk metric that is associated with the postoperative hospital length of stay after cardiac surgery.

Original languageEnglish (US)
Pages (from-to)4093-4099
Number of pages7
JournalJournal of cardiothoracic and vascular anesthesia
Issue number11
StatePublished - Nov 2022


  • cardiac surgery
  • liver stiffness
  • outcomes
  • perioperative care
  • risk stratification
  • shear wave elastography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Anesthesiology and Pain Medicine


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