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Should We Use the Model for End-Stage Liver Disease (MELD) to Predict Mortality After Colorectal Surgery?

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

We sought to determine the accuracy of the Model for End-Stage Liver Disease and the Mayo Clinic Postoperative Mortality Risk in Patients with Cirrhosis Calculator in patients with ascites who underwent colorectal surgery. The National Surgical Quality Improvement Program database was queried for patients with ascites who underwent a major colorectal operation. Predicted 90-day mortality rate based on the Model for End-Stage Liver Disease and 30-day mortality based on the Mayo Clinic Postoperative Mortality Risk in Patients with Cirrhosis Calculator were compared with observed 30-day mortality. The cohort contained 3137 patients with ascites who underwent a colorectal operation. The Model for End-Stage Liver Disease predicted that 252 (8 %) of patients with ascites undergoing colorectal operations would die within 90 days postoperatively, yet we observed 821 deaths (26 % mortality) within 30 days after surgery (p < 0.001). The Mayo Clinic Postoperative Mortality Risk in Patients with Cirrhosis Calculator predicted that 491 (16.6 % mortality) of patients with ascites undergoing colorectal operations would die within 30 days postoperatively, yet we observed 707 (23.9 % mortality) at 30 days (p < 0.01). We concluded that the current risk prediction models significantly under predict mortality in patients with ascites who underwent colorectal surgery.

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Authors and Affiliations

  1. Department of Colon and Rectal Surgery, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA, 01803, USA

    Haddon Jacob Pantel, Kristian D. Stensland, Todd D. Francone, Patricia L. Roberts, Peter W. Marcello, Thomas Read & Rocco Ricciardi

  2. Tufts University, Boston, MA, USA

    Jason Nelson & Rocco Ricciardi

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  1. Haddon Jacob Pantel
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  2. Kristian D. Stensland
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  3. Jason Nelson
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  4. Todd D. Francone
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  5. Patricia L. Roberts
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  6. Peter W. Marcello
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  7. Thomas Read
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  8. Rocco Ricciardi
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Correspondence to Haddon Jacob Pantel.

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The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

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Pantel, H.J., Stensland, K.D., Nelson, J. et al. Should We Use the Model for End-Stage Liver Disease (MELD) to Predict Mortality After Colorectal Surgery?. J Gastrointest Surg 20, 1511–1516 (2016). https://doi.org/10.1007/s11605-016-3167-2

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  • DOI: https://doi.org/10.1007/s11605-016-3167-2

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