The impact of cirrhosis and MELD score on postoperative morbidity and mortality among patients selected for liver resection

Independent associations between chronic liver disease, MELD, and postoperative outcomes among patients selected for liver resection have not been completely established. We hypothesized independent associations between MELD, cirrhosis, and postoperative mortality. Patient-level data from the target...

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Published in:	The American journal of surgery Vol. 220; no. 3; pp. 682 - 686
Main Authors:	Zaydfudim, Victor M., Turrentine, Florence E., Smolkin, Mark E., Bauer, Todd B., Adams, Reid B., McMurry, Timothy L.
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-09-2020 Elsevier Limited
Subjects:	Aged Chronic liver disease Cirrhosis Clinical outcomes Cohort Studies Comorbidity Data collection Datasets Female Hepatectomy Hepatic surgery Humans Liver Liver cirrhosis Liver Cirrhosis - complications Liver diseases Liver surgery Male Middle Aged Morbidity Mortality Patient Selection Patients Postoperative Complications - epidemiology Postoperative Complications - etiology Postoperative Complications - mortality Postoperative period Probability Regression analysis Regression models Retrospective Studies Risk Assessment Risk estimation Severity of Illness Index Statistical analysis Surgery Variables Risk estimation Liver surgery Chronic liver disease Hepatic surgery Clinical outcomes Hepatectomy
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Summary:	Independent associations between chronic liver disease, MELD, and postoperative outcomes among patients selected for liver resection have not been completely established. We hypothesized independent associations between MELD, cirrhosis, and postoperative mortality. Patient-level data from the targeted hepatectomy module and ACS NSQIP PUF during 2014–2015 were merged. Multivariable regression models with interaction effect between MELD and liver texture (normal, congested/fatty, cirrhotic) tested the independent effects of covariates on mortality and morbidity. 3,530 patients were included, of whom 668 patients (19%) had cirrhosis. ACS NSQIP defined mortality (3.9%vs1.1%) and morbidity (23.5%vs15.8%) were higher in patients with cirrhosis (both p < 0.001). In multivariable models, cirrhosis (OR = 2.24; 95%CI:1.16–4.34, p = 0.016) and MELD (OR = 1.10; 95%CI:1.03–1.18, p = 0.007) were independently associated with mortality. MELD (OR = 1.04; 95%CI:1.002–1.08, p = 0.038) was associated with postoperative morbidity. Higher MELD and presence of cirrhosis have an independent negative effect on mortality after liver resection. MELD could be used to estimate postoperative risk in patients with and without cirrhosis. •Both cirrhosis and MELD score are associated with mortality after liver resection.•The effects of MELD and cirrhosis on postoperative mortality are independent.•MELD score is associated with morbidity among patients selected for hepatectomy.•MELD can be used to estimate risk in patients with and without cirrhosis.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0002-9610 1879-1883
DOI:	10.1016/j.amjsurg.2020.01.022