Accuracy of MELD-Na as a Predictor of Morbidity and Mortality in Cirrhotic Patients With Ascites Undergoing General Surgical Procedures
*Nathan L. Maassel1, *Matthew M. Fleming1, *Jiajun Luo2, *Yawei Zhang2,3, Kevin Y. Pei1
1Yale, New Haven, CT; 2Section of Surgical Outcomes and Epidemiology, Department of Surgery, Yale School of Medicine, New Haven, CT; 3Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT
Objective: MELD-Na reportedly accounts for ascites in cirrhotic patients. This study determines whether the Model for End-Stage Liver Disease Sodium (MELD-Na) score accurately predicted morbidity and mortality in patients with ascites undergoing general surgery procedures.
Design: We analyzed the ACS NSQIP database (2005-2014) to examine the adjusted risk of morbidity and mortality of cirrhotic patients with and without ascites undergoing inguinal or ventral hernia repair, cholecystectomy, or lysis of adhesions for bowel obstruction. Patients were stratified by MELD-Na score and presence of ascites. Outcomes were compared between patients with and without ascites for each stratum using the low MELD-Na and no ascites group as a reference.
Setting: ACS NSQIP participating hospitals
Patients/Participants: Adult patients with liver disease who underwent one of these common general surgery procedures.
Interventions (if any): none.
Main Outcome Measures: adjusted morbidity and mortality stratified by MELD-Na.
Results: A total of 30,391 patients were analyzed. Within each MELD-Na stratum, patients with ascites had an increased risk of complications when compared to the reference group (low MELD-Na and no ascites): low MELD-Na with ascites OR 4.33 (95%CI 1.96-9.59), moderate MELD-Na no ascites OR 1.70 (95%CI 1.52-1.9), moderate MELD-Na with ascites OR 3.69 (95%CI 2.49-5.46), high MELD-Na no ascites OR 3.51 (95%CI 3.07-4.01), high MELD-Na ascites OR 7.18 (95%CI 5.33-9.67). Similarly, mortality risk was increased in patients with ascites when compared to those without: moderate MELD-Na no ascites OR 3.55 (95%CI 2.22-5.67), moderate MELD-Na ascites OR 13.80 (95%CI 5.65-33.71), high MELD-Na no ascites OR 8.34 (95%CI 5.15-13.51), high MELD-Na ascites OR 43.97 (95%CI 23.76-81.39).
Conclusions: MELD-Na underestimates morbidity and mortality risk for general surgery patients with ascites.