Association of mild-to-moderate Model for End-Stage Liver Disease scores on short-term cardiac surgery postoperative...

We assessed the Model for End-Stage Liver Disease score in patients with mild-moderate scores to predict perioperative outcomes in patients undergoing cardiac surgery.

The American College Surgeons National Surgical Quality Improvement Program was used to identify patients (2013-2022) undergoing elective isolated coronary artery bypass grafting, aortic valve surgery, or mitral valve surgery. Patients were stratified by low (<9), moderate (9-15), and high (>15) Model for End-Stage Liver Disease scores. Multivariable logistic regression and observed-to-expected ratios were used to assess Model for End-Stage Liver Disease group association and 30-day outcomes.

Of 25,845 patients, 17,743 underwent coronary artery bypass grafting, 5095 underwent aortic valve surgery, and 3007 underwent mitral valve surgery. Increasing Model for End-Stage Liver Disease score (low: n = 18,379; moderate: n = 5922; high: n = 1444) was associated with an increase in mortality for each Model for End-Stage Liver Disease point. The 30-day mortality (low [1.7%], moderate [3.8%], high [8.7%]) and major morbidity (low [25.1%], moderate [33.3%], high [45.7%]) increased with Model for End-Stage Liver Disease severity. Increasing Model for End-Stage Liver Disease category was an independent predictor of 30-day mortality (odds ratio, 1.76; 95% CI, 1.57-1.98) and morbidity (odds ratio, 1.07; 95% CI, 1.02-1.12). The 30-day mortality observed-to-expected ratio was lower in patients with low Model for End-Stage Liver Disease score (observed-to-expected ratio, 0.88; 95% CI, 0.79-0.97) and higher in patients with high Model for End-Stage Liver Disease score (observed-to-expected ratio, 1.15 95% CI, 1.01-1.29). Major morbidity was greater than predicted in all Model for End-Stage Liver Disease categories (all P < .05), driven by increased rates of respiratory complications, renal failure, thromboembolism, and sepsis.

Patients with moderate and low Model for End-Stage Liver Disease scores have adequate outcomes with respect to 30-day mortality. However, surgical risk for patients with high Model for End-Stage Liver Disease scores was underpredicted by traditional risk stratification. Patients with mild to moderate liver disease can undergo cardiac surgery with acceptable surgical mortality.