title: Should We Use the Model for End-Stage Liver Disease (MELD) to Predict Mortality After Colorectal Surgery?
abstract: We sought to determine the accuracy of the Model for End-Stage Liver Disease and the Mayo Clinic Postoperative Mortality Risk in Patients with Cirrhosis Calculator in patients with ascites who underwent colorectal surgery. The National Surgical Quality Improvement Program database was queried for patients with ascites who underwent a major colorectal operation. Predicted 90-day mortality rate based on the Model for End-Stage Liver Disease and 30-day mortality based on the Mayo Clinic Postoperative Mortality Risk in Patients with Cirrhosis Calculator were compared with observed 30-day mortality. The cohort contained 3137 patients with ascites who underwent a colorectal operation. The Model for End-Stage Liver Disease predicted that 252 (8 %) of patients with ascites undergoing colorectal operations would die within 90 days postoperatively, yet we observed 821 deaths (26 % mortality) within 30 days after surgery (p < 0.001). The Mayo Clinic Postoperative Mortality Risk in Patients with Cirrhosis Calculator predicted that 491 (16.6 % mortality) of patients with ascites undergoing colorectal operations would die within 30 days postoperatively, yet we observed 707 (23.9 % mortality) at 30 days (p < 0.01). We concluded that the current risk prediction models significantly under predict mortality in patients with ascites who underwent colorectal surgery.
authors.affiliation: Department of Colon and Rectal Surgery, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA, 01803, USA. haddon.pantel@lahey.org.
authors.forename: Haddon Jacob
authors.initials: HJ
authors.lastname: Pantel
authors.affiliation: Department of Colon and Rectal Surgery, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA, 01803, USA.
authors.forename: Kristian D
authors.initials: KD
authors.lastname: Stensland
authors.affiliation: Tufts University, Boston, MA, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Nelson
authors.affiliation: Department of Colon and Rectal Surgery, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA, 01803, USA.
authors.forename: Todd D
authors.initials: TD
authors.lastname: Francone
authors.affiliation: Department of Colon and Rectal Surgery, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA, 01803, USA.
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Roberts
authors.affiliation: Department of Colon and Rectal Surgery, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA, 01803, USA.
authors.forename: Peter W
authors.initials: PW
authors.lastname: Marcello
authors.affiliation: Department of Colon and Rectal Surgery, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA, 01803, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Read
authors.affiliation: Department of Colon and Rectal Surgery, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA, 01803, USA.|Tufts University, Boston, MA, USA.
authors.forename: Rocco
authors.initials: R
authors.lastname: Ricciardi
mesh_terms: D001201:Ascites / Q000150:complications* / Q000401:mortality; D015331:Cohort Studies; D003106:Colon / Q000601:surgery*; D058625:End Stage Liver Disease / Q000150:complications / Q000401:mortality; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D058996:Quality Improvement; D012007:Rectum / Q000601:surgery*
keywords: Ascites [C23.550.081]; Colorectal surgery [H02.403.810.208]; End-stage liver disease [C06.552.308.500.177]