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Updated: Apr 27, 2026
Laparoscopic Repair of Para-Esophageal Hernia Using Absorbable Biosynthetic Mesh
Published on: September 11, 2021
Hernia repair in the presence of ascites
Brett L Ecker1, Edmund K Bartlett1, Rebecca L Hoffman1
1Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
Background:
The model for end-stage liver disease (MELD) has been validated as a prediction tool for postoperative mortality, but its role in predicting morbidity has not been well studied. We sought to determine the role of MELD, among other factors, in predicting morbidity and mortality in patients with nonmalignant ascites undergoing hernia repair.
Methods:
All patients undergoing hernia repair in the American College of Surgeons National Surgical Quality Improvement database (2009-11) were identified. Those with nonmalignant ascites were compared with patients without ascites. A subset analysis of patients with nonmalignant ascites was performed to evaluate the association between MELD and morbidity and mortality with adjustment for potential confounders. The association of significant factors with the rate of morbidity was displayed using a best-fit polynomial regression.
Results:
Of 138,366 hernia repairs, 778 (0.56%) were performed on patients with nonmalignant ascites. Thirty-day morbidity (4% versus 19%) and mortality (0.2% versus 5.3%) were significantly more frequent in patients with ascites (P < 0.001). In univariate analysis of the 636 patients with a calculable MELD, MELD was associated with both morbidity and mortality (P < 0.001 each). In multivariate analysis, MELD remained significantly associated with morbidity (odds ratio [OR] = 1.11). Ventral hernia repair (OR = 2.9), dependent functional status (OR = 2.3), alcohol use (OR = 2.3), emergent operation (OR = 2.0) white blood count (OR = 1.1), and age (OR = 1.02) were also significantly associated with morbidity (P < 0.05).
Conclusions:
Before hernia repair, the MELD score can be used to risk-stratify patients with nonmalignant ascites not only for mortality but also morbidity. Morbidity rates increase rapidly with MELD above 15, but other factors should additionally be accounted for when counseling patients on their perioperative risk.
Insights
The Model for End-Stage Liver Disease (MELD) score predicts both morbidity and mortality in patients undergoing hernia repair with nonmalignant ascites. Higher MELD scores indicate increased perioperative risk, necessitating careful patient counseling.
Area of Science:
- Hepatology
- Surgical Outcomes Research
- Medical Informatics
Background:
- The Model for End-Stage Liver Disease (MELD) is established for predicting postoperative mortality.
- Its utility in predicting postoperative morbidity, particularly in patients with nonmalignant ascites undergoing hernia repair, remains understudied.
- Ascites is a known complication associated with increased surgical risk.
Purpose of the Study:
- To investigate the role of the MELD score in predicting both morbidity and mortality in patients with nonmalignant ascites undergoing hernia repair.
- To identify other significant factors associated with morbidity in this patient population.
Main Methods:
- Analysis of the American College of Surgeons National Surgical Quality Improvement Program database (2009-2011).
- Comparison of patients with nonmalignant ascites versus those without ascites undergoing hernia repair.
- Subset analysis of patients with nonmalignant ascites to assess the association between MELD score and outcomes, adjusting for confounders.
- Polynomial regression used to display the association between significant factors and morbidity rates.
Main Results:
- Patients with nonmalignant ascites had significantly higher 30-day morbidity (19% vs. 4%) and mortality (5.3% vs. 0.2%) rates compared to those without ascites (P < 0.001).
- In multivariate analysis, the MELD score was significantly associated with increased morbidity (OR = 1.11).
- Other significant predictors of morbidity included ventral hernia repair, dependent functional status, alcohol use, emergent operation, white blood cell count, and age.
Conclusions:
- The MELD score is a valuable tool for risk-stratifying patients with nonmalignant ascites for both perioperative morbidity and mortality prior to hernia repair.
- Morbidity risk increases substantially with MELD scores above 15.
- Comprehensive patient counseling regarding perioperative risk should incorporate MELD score alongside other identified risk factors.
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