Current methods of predicting risk of postoperative mortality in patients with cirrhosis are suboptimal.
The utility of the Model for End-stage Liver Disease (MELD) in predicting mortality after surgery other than liver transplantation is unknown.
Dr Patrick Kamath and colleagues from Minnesota determined risk factors for postoperative mortality in patients with cirrhosis.
|MELD score, and age predicted mortality|
The research team assessed 772 patients with cirrhosis who underwent major surgery.
The team reported that 586 patients underwent digestive surgery, 107 had orthopedic surgery, and 79 had cardiovascular surgery were studied.
Control groups of patients with cirrhosis included 303 undergoing minor surgical procedures, and 562 ambulatory patients.
Univariate and multivariable proportional hazards analyses were used to determine the relationship between risk factors and mortality.
The researchers found that patients undergoing major surgery were at increased risk for mortality up to 90 days postoperatively.
By multivariable analysis, only MELD score, American Society of Anesthesiologists class, and age predicted mortality at 30 and 90 days.
These factors also predicted mortality at 1 year, and long-term, independent of type or year of surgery.
The team found emergency surgery was the only independent predictor of duration of hospitalization postoperatively.
The researchers noted that 30-day mortality ranged from 6% to more than 50%.
The team observed that the relationship between MELD score and mortality persisted throughout the 20-year postoperative period.
Dr Kamath's team concluded, "MELD score, age, and American Society of Anesthesiologists class can quantify the risk of mortality postoperatively in patients with cirrhosis, independently of the procedure performed."
"These factors can be used in determining operative mortality risk, and whether elective surgical procedures can be delayed until after liver transplantation."