An assessment of different scoring systems in cirrhotic patients undergoing nontransplant surgery

Determining surgical risk in cirrhotic patients is difficult and multiple scoring systems have sought to quantify this risk. The purpose of our study was to assess the impact of Childs-Turcotte-Pugh (CTP), Model of End-Stage Liver Disease (MELD), and MELD-Sodium (MELD-Na) scores on postoperative morbidity and mortality for cirrhotic patients undergoing nontransplant surgery.

We performed a single-center retrospective review of all cirrhotic patients who underwent nontransplant surgery under general anesthesia over a 6-year period of time to analyze outcomes using the 3 scoring systems.

Sixty-four cirrhotic patients (mean age, 57 y; 62 men) underwent nontransplant surgery under general anesthesia. A CTP score of ≥ 7.5 was associated with an 8.3-fold increased risk of 30-day morbidity, a MELD score of ≥ 14.5 was associated with a 5.4-fold increased risk of 3-month mortality, and a MELD-Na score ≥ 14.5 was associated with a 4.5-fold increased risk of 1-year mortality. Emergent surgery, the presence of ascites, and low serum sodium level were associated significantly with morbidity and 1-year mortality.

The major strengths of the 3 scoring systems are for CTP in estimating 30-day morbidity, MELD for estimating 3-month mortality, and MELD-Na for estimating 1-year mortality.