OBJECTIVE: To determine if use of Model for End-Stage Liver Disease (MELD) scores to elective resections accurately predicts short-term morbidity or mortality. SUMMARY BACKGROUND DATA: MELD scores have been validated in the setting of end-stage liver disease for patients awaiting transplantation or undergoing transvenous intrahepatic portosystemic shunt procedures. Its use in predicting outcomes after elective hepatic resection has not been evaluated. METHODS: Records of 587 patients who underwent elective hepatic resection and were included in the National Surgical Quality Improvement Program Database were reviewed. MELD score, CTP score, Charlson Index of Comorbidity, American Society of Anesthesiology classification, and age were evaluated for their ability to predict short-term morbidity and mortality. Morbidity was defined as the development of one or more of the following complications: pulmonary edema or embolism, myocardial infarction, stroke, renal failure or insufficiency, pneumonia, deep venous thrombosis, bleeding, deep wound infection, reoperation, or hyperbilirubinemia. The analysis was repeated with patients divided according to their procedure and their primary diagnosis. Parametric or nonparametric analyses were performed as appropriate. Also, a new index was developed by dividing the patients into a development and a validation cohort, to predict morbidity and mortality in patients undergoing elective hepatic resection. ROC curves were also constructed for each of the primary indices. RESULTS: CTP and ASA scores were superior in predicting outcome. Also, patients undergoing resection of primary malignancies had a higher rate of mortality but no difference in morbidity. CONCLUSION: MELD scores should not be used to predict outcomes in the setting of elective hepatic resection.
OBJECTIVE: To determine if use of Model for End-Stage Liver Disease (MELD) scores to elective resections accurately predicts short-term morbidity or mortality. SUMMARY BACKGROUND DATA: MELD scores have been validated in the setting of end-stage liver disease for patients awaiting transplantation or undergoing transvenous intrahepatic portosystemic shunt procedures. Its use in predicting outcomes after elective hepatic resection has not been evaluated. METHODS: Records of 587 patients who underwent elective hepatic resection and were included in the National Surgical Quality Improvement Program Database were reviewed. MELD score, CTP score, Charlson Index of Comorbidity, American Society of Anesthesiology classification, and age were evaluated for their ability to predict short-term morbidity and mortality. Morbidity was defined as the development of one or more of the following complications: pulmonary edema or embolism, myocardial infarction, stroke, renal failure or insufficiency, pneumonia, deep venous thrombosis, bleeding, deep wound infection, reoperation, or hyperbilirubinemia. The analysis was repeated with patients divided according to their procedure and their primary diagnosis. Parametric or nonparametric analyses were performed as appropriate. Also, a new index was developed by dividing the patients into a development and a validation cohort, to predict morbidity and mortality in patients undergoing elective hepatic resection. ROC curves were also constructed for each of the primary indices. RESULTS:CTP and ASA scores were superior in predicting outcome. Also, patients undergoing resection of primary malignancies had a higher rate of mortality but no difference in morbidity. CONCLUSION: MELD scores should not be used to predict outcomes in the setting of elective hepatic resection.
Authors: Robert S Brown; K Shiva Kumar; Mark W Russo; Milan Kinkhabwala; Dianne L Rudow; Patricia Harren; Steven Lobritto; Jean C Emond Journal: Liver Transpl Date: 2002-03 Impact factor: 5.799
Authors: Richard B Freeman; Russell H Wiesner; Ann Harper; Sue V McDiarmid; Jack Lake; Erick Edwards; Robert Merion; Robert Wolfe; Jeremiah Turcotte; Lewis Teperman Journal: Liver Transpl Date: 2002-09 Impact factor: 5.799
Authors: B Angermayr; M Cejna; F Karnel; M Gschwantler; F Koenig; J Pidlich; H Mendel; L Pichler; M Wichlas; A Kreil; M Schmid; A Ferlitsch; E Lipinski; H Brunner; J Lammer; P Ferenci; A Gangl; M Peck-Radosavljevic Journal: Gut Date: 2003-06 Impact factor: 23.059
Authors: Sammy Saab; Victor Wang; Ayman B Ibrahim; Francisco Durazo; Steven Han; Douglas G Farmer; Hasan Yersiz; Marcia Morrisey; Leonard I Goldstein; R Mark Ghobrial; Ronald W Busuttil Journal: Liver Transpl Date: 2003-05 Impact factor: 5.799
Authors: Michael Schepke; Felix Roth; Rolf Fimmers; Karl August Brensing; Thomas Sudhop; Hans H Schild; Tilman Sauerbruch Journal: Am J Gastroenterol Date: 2003-05 Impact factor: 10.864
Authors: G Ercolani; Alessandro Cucchetti; Matteo Cescon; Matteo Ravaioli; Gian Luca Grazi; Antonio D Pinna Journal: Ann Surg Date: 2006-10 Impact factor: 12.969
Authors: T M Lodewick; P H Alizai; R M van Dam; A A J Roeth; M Schmeding; C Heidenhain; A Andert; N Gassler; C H C Dejong; U P Neumann Journal: Dig Surg Date: 2017-02-15 Impact factor: 2.588
Authors: Victor M Zaydfudim; Florence E Turrentine; Mark E Smolkin; Todd B Bauer; Reid B Adams; Timothy L McMurry Journal: Am J Surg Date: 2020-01-20 Impact factor: 2.565
Authors: Kathleen De Greef; Christian Rolfo; Antonio Russo; Thiery Chapelle; Giuseppe Bronte; Francesco Passiglia; Andreia Coelho; Konstantinos Papadimitriou; Marc Peeters Journal: World J Gastroenterol Date: 2016-08-28 Impact factor: 5.742