Risk factors and prognosis of postoperative hepatic dysfunction after Stanford type A aortic dissection repair: a systematic review and meta-analysis

Abstract

Evidence on postoperative hepatic dysfunction after Stanford type A aortic dissection repair remains limited. Existing studies have used heterogeneous definitions and have reported inconsistent perioperative factors and clinical outcomes. This systematic review and meta-analysis aimed to estimate the incidence of postoperative hepatic dysfunction, summarize associated perioperative variables, and evaluate its association with short-term postoperative outcomes. PubMed, Embase (Ovid), Web of Science, and the Cochrane Library were systematically searched for clinical studies investigating postoperative hepatic dysfunction in patients undergoing surgical repair for Stanford type A aortic dissection. Pooled analyses were performed to estimate the incidence of postoperative hepatic dysfunction and its associations with perioperative variables and postoperative outcomes. A total of 960 records were identified, and nine single-center retrospective cohort studies involving 3,234 patients were included. The pooled incidence of postoperative hepatic dysfunction was 37%. Male sex was associated with postoperative hepatic dysfunction (OR 1.35, 95% CI 1.10–1.64, I 2 = 0%). Compared with patients without postoperative hepatic dysfunction, those who developed postoperative hepatic dysfunction had higher preoperative white blood cell counts (MD 0.94 × 10⁹/L, 95% CI 0.21–1.67, I 2 = 67%), longer cardiopulmonary bypass time (MD 21.29 min, 95% CI 11.25–31.34, I 2 = 85%), longer aortic cross-clamp time (MD 11.57 min, 95% CI 7.88–15.26, I 2 = 52%), and greater perioperative red blood cell transfusion volume (MD 1.90 units, 95% CI 0.92–2.88, I 2 = 90%). Postoperative hepatic dysfunction was also associated with higher odds of short-term mortality (OR 5.59, 95% CI 3.96–7.88, I 2 = 0%) and acute kidney injury (OR 5.62, 95% CI 4.16–7.59, I 2 = 30%), as well as longer intensive care unit stay (MD 60.18 h, 95% CI 54.83–65.53, I 2 = 23%). Postoperative hepatic dysfunction was common after Stanford type A aortic dissection repair and was associated with worse short-term postoperative outcomes. Several preoperative and intraoperative variables were associated with postoperative hepatic dysfunction; however, the available evidence was limited by retrospective study designs, heterogeneous definitions, and residual confounding. Future multicenter studies using standardized definitions and systematically collected malperfusion-related, operative, and perfusion-related variables are needed to clarify its clinical significance and support risk-stratification research. PROSPERO CRD420251234391.