Patients with cirrhosis have increased surgical risk and require care team expertise. We explored the association between center cirrhosis surgical volume and postoperative mortality in a large VA data set. In this retrospective cohort study of 14,500 major surgeries in patients with cirrhosis, we found in adjusted analysis that high-volume centers (>
16 surgeries in past year) had a 36% reduced hazard of postoperative mortality through 90 days vs low-volume centers (<
9 surgeries in past year
hazard ratio 0.64, 95% confidence interval 0.43-0.94, P = 0.02). These findings demonstrate the importance of triaging patients with cirrhosis to high-volume centers for major surgery when feasible.