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 17 January 2018

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News

MELD scores not for predicting liver resection outcomes

March's issue of Annals of Surgery finds that CTP and American Society of Anesthesiology classification scores are superior in predicting outcome, and MELD scores should not be used to predict elective hepatic resection outcomes.

News image

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Model for End-Stage Liver Disease (MELD) scores have been validated in the setting of end-stage liver disease for patients awaiting transplantation.

It has also been validated in patients undergoing transvenous intrahepatic portosystemic shunt procedures.

However, its use in predicting outcomes after elective hepatic resection has not been evaluated.

Dr Rebecca Schroeder and colleagues determined evaluated the use of MELD scores in elective resections.

The research team assessed whether MELD accurately predicts short-term morbidity or mortality for this procedure.

The researchers reviewed the records of 587 patients.

The patients had undergone elective hepatic resection and were included in the National Surgical Quality Improvement Program Database.

MELD score, CTP score, Charlson Index of Comorbidity, American Society of Anesthesiology classification, and age were evaluated.

The researchers evaluated whether these factors predicted short-term morbidity and mortality.

Patients undergoing resection of primary malignancies had a higher rate of mortality
Annals of Surgery

Morbidity was defined as the development of 1 or more complications, including pulmonary edema or embolism, myocardial infarction, stroke, and bleeding.

Other complications assessed were renal failure or insufficiency, pneumonia, and deep venous thrombosis.

Deep wound infection, reoperation, or hyperbilirubinemia were also evaluated.

The analysis was repeated with patients divided according to their procedure and their primary diagnosis.

The team performed parametric or nonparametric analyses as appropriate.

Also, a new index was developed by dividing the patients into a development and a validation cohort.

This new index was used to predict morbidity and mortality in patients undergoing elective hepatic resection.

The researchers found that CTP and American Society of Anesthesiology classification scores were superior in predicting outcome.

Patients undergoing resection of primary malignancies had a higher rate of mortality but no difference in morbidity.

Dr Schroeder's team concluded, “MELD scores should not be used to predict outcomes in the setting of elective hepatic resection.”

Ann Surg 2006: 243(3): 373-9
02 March 2006

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