Introduction: Operative risk in cirrhotics is related to severity of liver disease and nature of the procedure. Elective and emergent abdominal surgery in cirrhotics is associated with increased perioperative mortality. Surgery can precipitate hepatic decompensation, as well as intraoperative bleeding and ascites, which can cause wound dehiscence and peritonitis. Preoperative portal decompression via TIPS may reduce the risk of complications and impact survival. However, in emergent surgeries pre-op TIPS is not feasible, and can be considered post-op. We report on the utility of pre- and post-operative TIPS in decompensated cirrhotics, and its effect on perioperative mortality. Methods: Between 2010-2017 at the UAB, 19 cirrhotics underwent TIPS prior to abdominal surgery, and four after. Mayo Clinic post-operative mortality risk calculator was used to determine the expected 30 and 90-day mortality, which was compared to the observed mortality in our cohort. Results: TIPS was successfully performed in 23 decompensated cirrhotics, 19 preoperatively and 4 postoperatively. The hepatic venous pressure gradient decreased from 13.7±3.1 to 5.8±2.1 mm Hg after postop TIPS, and from 16±4.7 to 5.3±2.5 mm Hg after pre-op TIPS. Mean time between pre-op TIPS and surgery was 39 days, and from surgery to post-op TIPS 9 days. The mean MELD score increased from 12.7±4.2 to 15.2±4.3 after preoperative-TIPS. Mean MELD at surgery was 13.2±3.9, and increased to 17.2±6.2 at post-operative TIPS. After preoperative TIPS, hepatic encephalopathy was reported in all 19 patients and ascites in six patients with two requiring revision of TIPS within 30 days after the surgery. One preoperative TIPS patient, with a Mayo 30-day mortality risk of 41%, died 78 days from surgery. One patient, with a Mayo 30-day mortality risk of 23%, died 48 hours post-op due to surgical complications, with TIPS placed 24 hours post-op. No wound dehiscence or peritonitis was reported. Conclusion: Decompression of the portal system has been noted to reduce mortality in high-risk surgical candidates prior to elective surgery. We show that both pre- and post-operative TIPS placement in decompensated cirrhotics may reduce mortality. Further studies are needed to validate our findings and identify a patient cohort that would most benefit. A key variable to be determined is the ideal time interval between TIPS and surgery to prevent multiple hits to the liver and limit the risk of hepatic decompensation.