title: An assessment of different scoring systems in cirrhotic patients undergoing nontransplant surgery.
abstract: BACKGROUND
  Determining surgical risk in cirrhotic patients is difficult and multiple scoring systems have sought to quantify this risk. The purpose of our study was to assess the impact of Childs-Turcotte-Pugh (CTP), Model of End-Stage Liver Disease (MELD), and MELD-Sodium (MELD-Na) scores on postoperative morbidity and mortality for cirrhotic patients undergoing nontransplant surgery.
  
  
  METHODS
  We performed a single-center retrospective review of all cirrhotic patients who underwent nontransplant surgery under general anesthesia over a 6-year period of time to analyze outcomes using the 3 scoring systems.
  
  
  RESULTS
  Sixty-four cirrhotic patients (mean age, 57 y; 62 men) underwent nontransplant surgery under general anesthesia. A CTP score of ≥ 7.5 was associated with an 8.3-fold increased risk of 30-day morbidity, a MELD score of ≥ 14.5 was associated with a 5.4-fold increased risk of 3-month mortality, and a MELD-Na score ≥ 14.5 was associated with a 4.5-fold increased risk of 1-year mortality. Emergent surgery, the presence of ascites, and low serum sodium level were associated significantly with morbidity and 1-year mortality.
  
  
  CONCLUSIONS
  The major strengths of the 3 scoring systems are for CTP in estimating 30-day morbidity, MELD for estimating 3-month mortality, and MELD-Na for estimating 1-year mortality.
authors.affiliation: Department of Surgery, Madigan Army Medical System, Madigan Health System, Tacoma, WA, USA.
authors.forename: Marlin Wayne
authors.initials: MW
authors.lastname: Causey
authors.affiliation: Department of Surgery, Madigan Army Medical System, Madigan Health System, Tacoma, WA, USA.
authors.forename: Scott R
authors.initials: SR
authors.lastname: Steele
authors.affiliation: Department of Surgery, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, NJ, USA.
authors.forename: Zachary
authors.initials: Z
authors.lastname: Farris
authors.affiliation: Department of Social Sciences, United States Military Academy, West Point, NY, USA.
authors.forename: David S
authors.initials: DS
authors.lastname: Lyle
authors.affiliation: Department of Surgery, Keller Army Community Hospital, 900 Washington Road, West Point, NY 10996, USA. Electronic address: Alan.Beitler@amedd.army.mil.
authors.forename: Alan L
authors.initials: AL
authors.lastname: Beitler
mesh_terms: D058625:End Stage Liver Disease; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index