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Assessing surgical risk calculators on hernia repair candidates with cirrhosis
S Y Xu1, J Jackson2, M I Goldblatt3
1Division of Minimally Invasive and Gastrointestinal Surgery, Department of Surgery, Medical College of Wisconsin, 8701 W Watertown Plank Rd, Wauwatosa, WI, 53226, USA.
Insights
The NSQIP Surgical Risk Calculator best predicts mortality for hernia repair in cirrhosis patients. Mayo Clinic
Area of Science:
- Hepatology
- Surgical Outcomes Research
Background:
- Risk calculators aid surgeons in estimating mortality for hernia repair in patients with severe liver disease.
- Accurate prediction of surgical risk is crucial for patient management and decision-making.
Purpose of the Study:
- To evaluate the accuracy of existing risk calculators for predicting mortality in patients with cirrhosis undergoing hernia repair.
- To identify the optimal patient population for utilizing these risk assessment tools.
Main Methods:
- Utilized American College of Surgeons National Surgery Quality Improvement Program (NSQIP) datasets (2013-2021).
- Assessed four risk calculators: Mayo Clinic's 'Post-operative Mortality Risk in Patients with Cirrhosis,' Model for End-Stage Liver Disease (MELD) score, NSQIP Surgical Risk Calculator, and a modified 5-item frailty index.
- Employed Receiver Operating Characteristic (ROC) curve analysis to determine predictive accuracy.
Main Results:
- The NSQIP Surgical Risk Calculator demonstrated the highest accuracy (AUC = 0.803, p < 0.001).
- Mayo Clinic's calculator showed good performance for specific etiologies (AUC = 0.722, p < 0.001), as did the MELD score (AUC = 0.709, p < 0.001).
- The modified frailty index had lower predictive accuracy (AUC = 0.583, p = 0.04).
Conclusions:
- The NSQIP Surgical Risk Calculator is superior for predicting 30-day mortality in patients with ascites undergoing hernia repair.
- In cases where NSQIP calculator data is incomplete, Mayo Clinic's calculator is recommended over the MELD score for risk assessment.
Purpose:
Several risk calculators have been developed and deployed to help surgeons estimate the mortality risk that comes with performing hernia repair surgery on patient with severe liver disease. This study seeks to evaluate the accuracy of these risk calculators on patients with cirrhosis and identify the most suitable population of patient to use these calculators on.
Methods:
The American College of Surgeons National Surgery Quality Improvement Program (NSQIP) 2013-2021 datasets were queried for patients who underwent hernia repair surgery. Mayo Clinic's "Post-operative Mortality Risk in Patients with Cirrhosis" risk calculator, Model for End-Stage Liver Disease (MELD) calculator, NSQIP's Surgical Risk Calculator, and a surgical 5-item modified frailty index were assessed to determine whether they accurately predict mortality following abdominal hernia repair.
Results:
In total, 1368 patients met inclusion criteria. Receiver operating characteristic (ROC) curve analysis of the 4 mortality risk calculators resulted in the following: NSQIP Surgical Risk Calculator = 0.803 (p < 0.001); "Post-operative Mortality Risk in Patients with Cirrhosis" with an etiology of "Alcoholic or Cholestatic" yielded an AUC = 0.722 (p < 0.001); MELD score yielded an AUC = 0.709 (p < 0.001); and the modified 5-item frailty index yielded an AUC = 0.583 (p = 0.04).
Conclusion:
The NSQIP Surgical Risk Calculator more accurately predicts 30-day mortality in patients with ascites undergoing hernia repair. However, if the patient is missing one of the 21 input variables required by this calculator, Mayo Clinic's 30-day mortality calculator should be consulted before the more widely used MELD score.
