The impact of Model for End-Stage Liver Disease-Na in predicting morbidity and mortality following elective colon cancer surgery irrespective of underlying liver disease.
BACKGROUND
The Model for End-Stage Liver Disease Sodium Model (MELD-Na) is a validated scoring system that uses bilirubin, international normalized ratio, serum creatinine, and sodium to predict mortality in cirrhotic patients awaiting liver transplantation. The aim of this study was to identify the utility of MELD-Na to predict patient outcomes, with and without liver disease, after elective colon cancer surgery.


METHODS
A review of the American College of Surgeons National Surgical Quality Improvement Program database (2005 to 2010) was conducted to calculate risk-adjusted 30-day outcomes using regression modeling.


RESULTS
A total of 10,842 patients (mean age, 68 years; 51% women) were included. MELD-Na scores were higher in men (10.2 vs 9.1, P < .001) and in open procedures (9.9 vs 9.1, P < .001). The overall complication and mortality rates were 26.3% and 3.3%, respectively. Incremental increases in MELD-Na score correlated with a 1.2% increase in mortality and a 1.1% increase in complications. On multivariate analysis, complications increased with MELD-Na score (odds ratio [OR], 1.05 per 1 point increase; 95% confidence interval [CI], 1.038 to 1.066). MELD-Na score was also associated with increased mortality (OR, 1.13; 95% CI, 1.1 to 1.16), along with ascites (OR, 5.7; 95% CI, 3.7 to 8.8) and corticosteroids (OR, 2.1; 95% CI, 1.3 to 3.3).


CONCLUSIONS
Elevated preoperative MELD-Na score is significantly associated with worse outcomes after elective resection for colon cancer.
Department of Surgery, Madigan Army Medical System, Madigan Health System, 9040a Fitzsimmons Dr, Tacoma, WA 98431, USA.
Marlin Wayne
MW
Causey
Department of Surgery, Madigan Army Medical System, Madigan Health System, 9040a Fitzsimmons Dr, Tacoma, WA 98431, USA.
Daniel
D
Nelson
Department of Surgery, Madigan Army Medical System, Madigan Health System, 9040a Fitzsimmons Dr, Tacoma, WA 98431, USA.
Eric K
EK
Johnson
University of Massachusetts Memorial Medical Center, Worcester, MA, USA.
Justin
J
Maykel
University of Cincinnati, Cincinnati, OH, USA.
Brad
B
Davis
Catholic Health Services of Long Island, Rockville Centre, NY, USA.
David E
DE
Rivadeneira
Case Western, Cleveland, OH, USA.
Brad
B
Champagne
Department of Surgery, Madigan Army Medical System, Madigan Health System, 9040a Fitzsimmons Dr, Tacoma, WA 98431, USA. Electronic address: harkersteele@mac.com.
Scott R
SR
Steele
D000368:Aged; D003082:Colectomy / Q000379:methods*; D003110:Colonic Neoplasms / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D017558:Elective Surgical Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008107:Liver Diseases / Q000175:diagnosis; D017093:Liver Failure / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D011184:Postoperative Period; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014481:United States / Q000453:epidemiology
Colectomy; MELD; MELD-Na; NSQIP