Model for End-Stage Liver Disease (MELD) Underestimates Morbidity and Mortality in Patients With Ascites
*Matthew Fleming1, *Fangfang Liu2, *Yawei Zhang3, *Kevin Y. Pei1
1Yale School of Medicine, Department of Surgery, New Haven, CT;2Beijing 302 Hospital, Beijing, China3Yale School of Medicine, Department of Environmental Health Sciences, New Haven, CT
Objective: To evaluate whether the Model for End-Stage Liver Disease (MELD) accurately predicts morbidity and mortality in cirrhotic patients with and without ascites undergoing colectomy.
Design: We performed a retrospective review of the National Surgical Quality Improvement Program (NSQIP) database (2005- 2014) to calculate risk adjusted morbidity and mortality of cirrhotic patients with and without ascites undergoing colectomy for diverticulitis.
Setting: NSQIP participating hospitals.
Patients: Patients with liver disease who underwent laparoscopic or open colectomy for diverticulitis from 2005-2014.
Main Outcome Measures: Adjusted morbidity and mortality following colectomy stratified by MELD with and without ascites.
There were 21,159 (47.7%) open colectomies and 23,191 (52.3%) laparoscopic colectomies. For each MELD stratum (low, medium, high), patients with ascites were found to have increased risk of complications compared to those without ascites, using low MELD and no ascites as reference (low MELD with ascites OR 1.37 P=0.031, moderate MELD with no ascites OR 1.49 and P<0.0001, moderate MELD with ascites OR 2.53 P < 0.0001, high MELD no ascites OR 2.26 P<0.0001, high MELD with ascites OR 4.61 P<0.0001). These trends also hold true for mortality (low MELD with ascites OR 4.49 P=0.0069, moderate MELD no ascites OR 1.75 P<0.0001, moderate MELD with ascites OR 8.59 P<0.0001, high MELD no ascites OR 4.04 P>0.0001, high MELD with ascites OR 15.36 P<0.0001).
The presence of ascites predicts an increased risk for perioperative morbidity and mortality for cirrhotic patients undergoing colectomy for all MELD classifications. These findings suggest that the MELD score significantly underestimates perioperative morbidity and mortality as it does not account for ascites.
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