An assessment of different scoring systems in cirrhotic patients undergoing nontransplant surgery

• Published in: The American journal of surgery Vol. 203; no. 5; pp. 589 - 593
• Main Authors: Causey, Marlin Wayne, M.D, Steele, Scott R., M.D, Farris, Zachary, M.D, Lyle, David S., Ph.D, Beitler, Alan L., M.D
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.05.2012; Elsevier; Elsevier Limited
• Subjects: Ascites; Biological and medical sciences; Cancer; Childs-Turcotte-Pugh; Cirrhosis; End Stage Liver Disease; Female; Gastroenterology. Liver. Pancreas. Abdomen; General aspects; Humans; Liver cirrhosis; Liver Cirrhosis - surgery; Liver diseases; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; MELD; MELD-Na; Middle Aged; Morbidity; Mortality; Other diseases. Semiology; Patients; Retrospective Studies; Risk Assessment; Severity of Illness Index; Sodium; Surgery; Surgical outcomes; Transplants & implants; Cirrhosis; MELD; MELD-Na; Childs-Turcotte-Pugh; Surgery; Human; Medicine; Treatment; Evaluation scale; Digestive diseases; Hepatic disease; Patient
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2012.01.009

Abstract Background Determining surgical risk in cirrhotic patients is difficult and multiple scoring systems have sought to quantify this risk. The purpose of our study was to assess the impact of Childs-Turcotte-Pugh (CTP), Model of End-Stage Liver Disease (MELD), and MELD-Sodium (MELD-Na) scores on postoperative morbidity and mortality for cirrhotic patients undergoing nontransplant surgery. Methods We performed a single-center retrospective review of all cirrhotic patients who underwent nontransplant surgery under general anesthesia over a 6-year period of time to analyze outcomes using the 3 scoring systems. Results Sixty-four cirrhotic patients (mean age, 57 y; 62 men) underwent nontransplant surgery under general anesthesia. A CTP score of ≥7.5 was associated with an 8.3-fold increased risk of 30-day morbidity, a MELD score of ≥14.5 was associated with a 5.4-fold increased risk of 3-month mortality, and a MELD-Na score ≥14.5 was associated with a 4.5-fold increased risk of 1-year mortality. Emergent surgery, the presence of ascites, and low serum sodium level were associated significantly with morbidity and 1-year mortality. Conclusions The major strengths of the 3 scoring systems are for CTP in estimating 30-day morbidity, MELD for estimating 3-month mortality, and MELD-Na for estimating 1-year mortality.