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.
OBJECTIVE
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.


METHODS
Retrospective medical record review.


METHODS
Tertiary care institution.


METHODS
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.


METHODS
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.
Befeler
Alex S
AS
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Saint Louis University, St Louis, MO 63110, USA.
Palmer
Dean E
DE
Hoffman
Martin
M
Longo
Walter
W
Solomon
Harvey
H
Di Bisceglie
Adrian M
AM
D000328:Adult; D000368:Aged; D005260:Female; D006305:Health Status Indicators; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007813:Laparotomy / Q000009:adverse effects / Q000379:methods; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D017093:Liver Failure / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome