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The Safety of Intra-abdominal Surgery in Patients With Cirrhosis
Model for End-Stage Liver Disease Score Is Superior to Child-Turcotte-Pugh Classification in Predicting Outcome
Alex S. Befeler, MD;
Dean E. Palmer, MD;
Martin Hoffman, DO;
Walter Longo, MD;
Harvey Solomon, MD;
Adrian M. Di Bisceglie, MD
Arch Surg. 2005;140:650-654.
Hypothesis We hypothesized that the model for end-stage liver disease (MELD) score may be a better and less subjective method than the Child-Turcotte-Pugh score for stratifying patients with cirrhosis before abdominal surgery.
Design Retrospective medical record review.
Setting Tertiary care institution.
Patients Fifty-three adult patients with histologically proven cirrhosis undergoing abdominal surgery at Saint Louis University Hospital, St Louis, Mo, between 1991 and 2001. Those undergoing hepatic surgery (such as resection or transplantation) or closed abdominal surgery (such as hernia repair) were excluded.
Main Outcome Measure A poor outcome after surgery was defined as death or liver transplantation within 90 days of the operative procedure or a hospital stay of longer than 21 days. Demographic, clinical, and laboratory features predictive of poor outcome were assessed by multivariate analysis.
Results A total of 13 patients (25%) had poor outcomes including 9 deaths (17%). Model for end-stage liver disease score and plasma hemoglobin levels lower than 10 g/dL were found to be independent predictors of poor outcomes. A MELD score of 14 or greater was a better clinical predictor of poor outcome than Child-Turcotte-Pugh class C.
Conclusions A MELD score of 14 or greater should be considered as a replacement for Child-Turcotte-Pugh class C as a predictor of being very high risk for abdominal surgery. Patients with cirrhosis with hemoglobin levels lower than 10 g/dL should receive corrective blood transfusions before abdominal surgery.
Author Affiliations: Division of Gastroenterology and Hepatology, Department of Internal Medicine (Drs Befeler, Palmer, Hoffman, and Di Bisceglie) and the Department of Surgery (Drs Longo and Soloman), Saint Louis University, St Louis, Mo. Dr Hoffman is now with Connecticut Gastroenterology Associates, Hartford. Dr Longo is now with the Department of Surgery, Yale University, New Haven, Conn.
RELATED ARTICLE
The Safety of Intra-abdominal Surgery in Patients With Cirrhosis—Invited Critique
Jack Pickleman
Arch Surg. 2005;140(7):655.
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