We performed a retrospective cohort study of patients with cirrhosis using well-phenotyped, longitudinal data from the Veterans Outcomes and Costs Associated with Liver Disease (VOCAL) cohort, which contains data from 128 VHA hospitals. The derivation of the VOCAL cohort has been previously described;12 (link) in brief, it contains medical data on over 129,000 patients with cirrhosis identified between 2008 and 2016, and has been used for numerous natural history studies of chronic liver disease.13 –19 We merged VOCAL with the Veterans Affairs Surgical Quality Improvement Program (VASQIP) dataset.20 (link) This dataset contains prospectively adjudicated data on VHA surgical procedures, including pre-operative, intraoperative, and post-operative data with validated reliability.21 (link) After the VOCAL-VASQIP data merge, we included all patients at least 18 years of age with cirrhosis, defined using a validated algorithm based on International Classification of Diseases (ICD) codes.22 (link) We excluded patients who did not receive a surgical procedure of interest (hepatic surgeries, minor surgeries, or those with accepted low risk; detailed below), those who received liver transplantation prior to surgery, and those who had a pre-operative ASA classification of 5 due to exceptional circumstances of these cases and associated very high morbidity and mortality. We also excluded patients with insufficient pre-operative laboratory data to compute the MELD-Na and MRS, using a window of 30 days prior to surgery. Finally, surgery categories in which fewer than 50 procedures were performed were excluded given limited statistical power to draw inferences associated with mortality; this resulted in the exclusion of central nervous system (CNS) surgeries.