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Model for End-Stage Liver Disease Underestimates Morbidity and Mortality in Patients with Ascites Undergoing

Matthew M Fleming1, Fangfang Liu2,3, Yawei Zhang2,4

  • 1Section of General Surgery, Trauma, and Surgical Critical Care, Department of Surgery, Yale School of Medicine, 330 Cedar Street, BB310, New Haven, CT, 06519, USA.

World Journal of Surgery
|March 16, 2018
PubMed
Abstract

Insights

The Model for End-Stage Liver Disease (MELD) score underestimates surgical risk in cirrhotic patients with ascites. Ascites significantly increases postoperative morbidity and mortality, necessitating its inclusion in risk assessment for liver disease patients.

Area of Science:

  • Hepatology
  • Surgical Outcomes
  • Risk Stratification

Background:

  • The Model for End-Stage Liver Disease (MELD) score is used to assess surgical risk in patients with liver disease.
  • Ascites, a common complication of cirrhosis, is not incorporated into the MELD score.
  • The current MELD score may not accurately stratify surgical risk for patients with ascites.

Purpose of the Study:

  • To evaluate the accuracy of the MELD score in risk stratifying cirrhotic patients with ascites undergoing colectomy.
  • To determine if ascites independently predicts increased morbidity and mortality in this patient population.

Main Methods:

  • Analysis of the American College of Surgeons National Surgical Quality Improvement Program database (2005-2014).
  • Inclusion of cirrhotic patients undergoing colectomy for diverticulitis, stratified by MELD score and presence of ascites.
  • Multivariable logistic regression to control for demographic factors and comorbidities.

Main Results:

  • Ascites was associated with increased postoperative morbidity and mortality across all MELD score strata.
  • For high MELD patients, ascites increased morbidity odds by 3.54 and mortality odds by 9.91.
  • Even low MELD patients with ascites showed increased mortality risk (OR 2.91).

Conclusions:

  • Ascites is a significant independent predictor of increased postoperative morbidity and mortality in cirrhotic patients undergoing colectomy.
  • The MELD score underestimates surgical risk because it does not account for the presence of ascites.
  • Clinical risk assessment for cirrhotic patients should incorporate the presence of ascites.

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