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MELD score is predictive of postoperative morbidity and mortality in patients with acute appendicitis undergoing
Fady Daniel1, Mariam Baydoun2, Ali R Chaitou2
1Division of Gastroenterology and Hepatology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon. fd21@aub.edu.lb.
Background:
The model for end-stage liver disease (MELD) score has been shown to be a valid predictive tool for postoperative risks across various types of surgeries, after initially being restricted to liver transplantation eligibility assessment in cirrhotic patients. Since appendectomy is one of the most common surgical procedures, our objective is to compare the impact of the three versions of the MELD score (1.0, 2.0, and 3.0) on the risk assessment of 30-day postoperative morbidity and mortality in patients undergoing appendectomy for acute appendicitis.
Methods:
Data on patients undergoing appendectomy for acute appendicitis were collected from the ACS-NSQIP database from 2018 to 2022 using the Current Procedural Terminology (CPT) codes 44,950, 44,960, and 44,970. The different MELD scores and outcomes were compared using the Chi-square test. The outcomes measured included 30-day mortality, wound infection, cardiac, respiratory, urinary, and central nervous system complications, thromboembolism, sepsis, bleeding, return to the operating room, and composite morbidity.
Results:
A total of 121,207 patients were included, with a mean age of 45.31 ± 17.89 years, of which 58,495 (48.3%) were females. The majority, 102,895 (90.7%) patients, underwent laparoscopic appendectomy, whereas 10,599 (9.3%) had open appendectomy. The overall 30-day surgical mortality was 0.5% (567/121,207), and postoperative sepsis was observed in 5.8% (7,063/121,207). All the MELD score versions significantly predicted the outcomes independently of the surgical approach (laparoscopic/open appendectomy, simple/complicated appendicitis) with means of 8.21 ± 2.81, 9.01 ± 3.39, and 9.21 ± 3.26 for MELD 1.0, MELD 2.0, and MELD 3.0 scores, respectively. MELD 3.0 score noticeably outperformed its predecessors regarding all the outcomes. Patients with a score ≥ 11 had a higher prevalence of postoperative complications.
Conclusion:
The MELD score, in its three versions, is a valid tool for assessing 30-day morbidity and mortality risk following appendectomy for acute appendicitis. MELD 3.0, with a cutoff of 11, demonstrated superior predictive performance.
Insights
The Model for End-Stage Liver Disease (MELD) score effectively predicts postoperative risks for appendectomy patients. MELD 3.0 shows the best performance in assessing 30-day morbidity and mortality.
Area of Science:
- Surgical outcomes research
- Predictive modeling in medicine
- Gastroenterology and hepatology
Background:
- The Model for End-Stage Liver Disease (MELD) score, initially for liver transplant eligibility, is now used for general surgical risk assessment.
- Appendectomy is a common procedure, necessitating accurate risk stratification for postoperative complications.
Purpose of the Study:
- To compare the predictive accuracy of three MELD score versions (1.0, 2.0, and 3.0) for 30-day postoperative morbidity and mortality in patients undergoing appendectomy.
- To evaluate the MELD score's utility in assessing appendectomy outcomes across different surgical approaches and appendicitis severities.
Main Methods:
- Retrospective analysis of appendectomy cases from the ACS-NSQIP database (2018-2022).
- Utilized Current Procedural Terminology (CPT) codes 44,950, 44,960, and 44,970 for patient identification.
- Compared MELD 1.0, 2.0, and 3.0 scores against outcomes like mortality, infection, organ complications, thromboembolism, sepsis, bleeding, and return to OR using Chi-square tests.
Main Results:
- Included 121,207 patients (mean age 45.31 ± 17.89 years; 48.3% female).
- Laparoscopic appendectomy was performed in 90.7% of cases.
- All MELD versions predicted outcomes independently of surgical approach; MELD 3.0 demonstrated superior predictive performance. Patients with MELD scores ≥11 had increased postoperative complications.
Conclusions:
- The MELD score, across its three versions, is a valid tool for predicting 30-day morbidity and mortality risk after appendectomy for acute appendicitis.
- MELD 3.0, particularly with a cutoff score of 11, offers enhanced predictive accuracy for these outcomes.
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