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

MELD 3.0 is a composite score used to predict mortality due to liver disease. Obesity is increasingly linked to liver disease and cirrhosis. Bariatric surgery is the most effective and durable method of managing morbid obesity and significantly improves many associated comorbid conditions, yet it is not without risk. Determining a reasonable risk profile for bariatric surgery is a complex decision made more difficult by lack of data regarding morbidity and mortality.

We used data from the National Surgical Quality Improvement Program (NSQIP) from 2017-2019 to 2021-2022. Patients who underwent Roux-en-Y gastric bypass or sleeve gastrectomy were included. Each patient's MELD 3.0 score was calculated. The primary outcome was mortality, calculated at each MELD 3.0 score. A line of best fit was constructed and used to calculate expected mortality rates for each MELD 3.0.

We identified 17,866 patients. Absolute observed mortality rates remained under 1% up to a MELD 3.0 of 18. Additionally, 167 patients with a MELD 3.0 greater than 20 were identified with only 1 mortality. The line of best fit showed an r² value of 0.903 with predicted mortality remaining below 1% at a MELD 3.0 of 13, and below 4% at MELD 3.0 of 18. Due to insufficient data, the predictiveness of the model decreased above a MELD 3.0 of 19.

Our data suggests that there are specific patients with seemingly prohibitive MELD 3.0 scores who are able to safely undergo bariatric surgery. A high MELD 3.0 score is not an absolute contraindication for bariatric surgery. Further research exploring safe patient selection criteria could allow bariatric surgeons to identify a group of patients that had previously been thought too high-risk for bariatric surgery, but who could benefit immensely from the weight loss and improvement in comorbid conditions that bariatric surgery provides.