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Can the MELD score predict perioperative morbidity for patients with liver cirrhosis undergoing laparoscopic
Juliane Bingener1, Diane Cox, Joel Michalek
1Department of Surgery, University of Texas Health Science Center at San Antonio, Texas 78229, USA. bingenercas@uthscsa.edu
Abstract:
The Model for End Stage Liver Disease (MELD) score is a mortality predictor in patients awaiting liver transplantation. We evaluated the MELD score's ability to predict morbidity for patients with cirrhosis undergoing laparoscopic cholecystectomy. From March 1991 to February 2004, data of all patients undergoing laparoscopic cholecystectomy were prospectively collected. Data of patients with liver cirrhosis were reviewed. The MELD and Child scores were correlated with outcome variables. Of 7859 patients undergoing laparoscopic cholecystectomy, 99 patients (1.3%) exhibited liver cirrhosis, 44 women and 55 men. The mean age was 55 years (range, 28 to 92 years). The mortality rate was 6.3 per cent, morbidity rate 18 per cent, and conversion rate 11 per cent. Laboratory values on 55 patients were available to calculate MELD scores. The mean MELD score was 11 (range, 6 to 23). There was no significant variation in MELD scores with gender (P = 0.61) or cirrhosis etiology, alcoholic and nonalcoholic (P = 0.52). MELD and Child's score correlated well (P < 0.001); however, the risk of complication was not related to the MELD (P = 0.94) or Child-Pugh-Turcotte score (P = 0.26). Morbidity for patients with liver cirrhosis undergoing laparoscopic cholecystectomy remains high. The MELD score is useful for transplant risk stratification for but requires further investigation regarding morbidity prediction for laparoscopic cholecystectomy.
Insights
The Model for End Stage Liver Disease (MELD) score predicts liver transplant mortality but not morbidity in cirrhosis patients undergoing gallbladder removal. Morbidity remains high in these patients.
Area of Science:
- Hepatology
- Surgical Outcomes
- Medical Informatics
Background:
- The Model for End Stage Liver Disease (MELD) score is established for predicting mortality in liver transplant candidates.
- Laparoscopic cholecystectomy is a common procedure, but outcomes in patients with liver cirrhosis are less understood.
Purpose of the Study:
- To evaluate the MELD score's effectiveness in predicting morbidity for patients with liver cirrhosis undergoing laparoscopic cholecystectomy.
- To assess the correlation between MELD and Child scores with post-operative outcomes in this patient group.
Main Methods:
- Prospective data collection of 7859 laparoscopic cholecystectomies from March 1991 to February 2004.
- Review of data for 99 patients (1.3%) with liver cirrhosis, including MELD score calculation for 55 patients.
- Correlation analysis of MELD and Child scores with morbidity, mortality, and conversion rates.
Main Results:
- The study included 99 cirrhotic patients (mean age 55 years); mortality was 6.3%, morbidity 18%, and conversion 11%.
- Mean MELD score was 11, with no significant variation by gender or cirrhosis etiology.
- MELD and Child scores correlated well (P < 0.001), but neither predicted complication risk (MELD P = 0.94; Child-Pugh-Turcotte P = 0.26).
Conclusions:
- Morbidity following laparoscopic cholecystectomy in patients with liver cirrhosis remains significantly high.
- While the MELD score is valuable for transplant risk stratification, its utility in predicting morbidity for this specific surgical procedure requires further investigation.