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Does Preoperative MELD Score Predict Adverse Outcomes Following Pancreatic Resection: an ACS NSQIP Analysis

  • Amr I. Al Abbas
  • Jeffrey D. Borrebach
  • Johanna Bellon
  • Amer H. ZureikatEmail author
Original Article
  • 53 Downloads

Abstract

Background

Higher MELD scores correlate with adverse operative outcomes regardless of the presence of liver disease, but their impact on pancreatectomy outcomes remains undefined. We aimed to compare 30-day adverse postoperative outcomes of patients undergoing elective pancreatectomy stratified by MELD score.

Methods

Elective pancreatoduodenectomies (PDs) and distal pancreatectomies (DPs) were identified from the 2014–2016 ACS NSQIP Procedure Targeted Pancreatectomy Participant Use Data Files. Outcomes examined included mortality, cardiopulmonary complications, prolonged postoperative length-of-stay, discharge not-to-home, transfusion, POPF, CR-POPF, any complication, and serious complication. Outcomes were compared between MELD score strata (< 11 vs. ≥ 11) as established by the United Network for Organ Sharing (UNOS). Multivariable logistic regression models were constructed to examine the risk-adjusted impact of MELD score on outcomes.

Results

A total of 7580 PDs and 3295 DPs had evaluable MELD scores. Of these, 1701 PDs and 223 DPs had a MELD score ≥ 11. PDs with MELD ≥ 11 exhibited higher risk for mortality (OR = 2.07, p < 0.001), discharge not-to-home (OR = 1.26, p = 0.005), and transfusion (OR = 1.7, p < 0.001). DP patients with MELD ≥ 11 demonstrated prolonged LOS (OR = 1.75, p < 0.001), discharge not-to-home (OR = 1.83, p = 0.01), and transfusion (OR = 2.78, p < 0.001). In PD, MELD ≥ 11 was independently predictive of 30-day mortality (OR = 1.69, p = 0.007) and transfusion (OR = 1.55, p < 0.001). In DP, MELD ≥ 11 was independently predictive of prolonged LOS (OR = 1.42, p = 0.026) and transfusion (OR = 2.3, p < 0.001).

Conclusion

A MELD score ≥ 11 is associated with a near twofold increase in the odds of mortality following pancreatoduodenectomy. The MELD score is an objective assessment that aids in risk-stratifying patients undergoing pancreatectomy.

Keywords

Pancreatectomy Pancreatoduodenectomy Distal pancreatectomy Liver disease MELD 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors have declare that they have no conflicts of interest.

Supplementary material

11605_2019_4380_MOESM1_ESM.docx (28 kb)
ESM 1 (DOCX 27 kb)

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Copyright information

© The Society for Surgery of the Alimentary Tract 2019

Authors and Affiliations

  • Amr I. Al Abbas
    • 1
  • Jeffrey D. Borrebach
    • 2
  • Johanna Bellon
    • 2
  • Amer H. Zureikat
    • 1
    • 3
    Email author
  1. 1.University of Pittsburgh Medical CenterPittsburghUSA
  2. 2.The Wolff Center at UPMCPittsburghUSA
  3. 3.Division of GI Surgical Oncology, UPMC Pancreatic Cancer CenterUniversity of Pittsburgh Medical CenterPittsburghUSA

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