High MELD 3.0 score is not an absolute contraindication to bariatric surgery

Area of Science:

• Hepatology
• Bariatric Surgery
• Medical Informatics

Background:

• Obesity is a growing concern, often linked to liver disease and cirrhosis.
• Bariatric surgery effectively manages morbid obesity and related conditions but carries risks.
• Assessing bariatric surgery risk is complex due to limited data on morbidity and mortality.

Purpose of the Study:

• To evaluate the safety and mortality risk of bariatric surgery in patients with elevated MELD 3.0 scores.
• To determine if high MELD 3.0 scores are absolute contraindications for bariatric surgery.
• To inform patient selection criteria for bariatric procedures in liver disease patients.

Main Methods:

• Utilized National Surgical Quality Improvement Program (NSQIP) data from 2017-2019 and 2021-2022.
• Included patients undergoing Roux-en-Y gastric bypass or sleeve gastrectomy.
• Calculated MELD 3.0 scores and analyzed mortality rates, constructing a line of best fit.

Main Results:

• Observed mortality remained below 1% for MELD 3.0 scores up to 18.
• 167 patients with MELD 3.0 > 20 had only one mortality event.
• Predicted mortality was <1% at MELD 3.0 of 13 and <4% at MELD 3.0 of 18.

Conclusions:

• Elevated MELD 3.0 scores do not appear to be absolute contraindications for bariatric surgery.
• Specific patient selection criteria may allow safer surgical options for high-risk individuals.
• Further research can identify patients who could benefit from bariatric surgery despite seemingly prohibitive MELD 3.0 scores.