M. L. Kueht1, E. Godfrey1, Z. Pallister1, S. Awad1 1Baylor College Of Medicine,Houston, TX, USA
Introduction: The concept of delta MELD, the change in MELD score over a certain time period, has been shown to be a predictor of waitlist mortality, but not post-operative outcomes in liver transplantation. Liver transplantation is unique in that it improves liver function and transplant patients are generally free from significant cardiac disease; we sought to explore the effect of changing MELD scores on outcomes in non-transplant surgery.
Methods: We conducted a retrospective analysis of all emergency surgeries on patients with documented cirrhosis at the MEDVAMC between 2001 and 2012. Delta MELD was calculated as the difference between MELD on the day of surgery (acute MELD) and a MELD calculated between 7 days and 9 months prior to the operation. Univariate analysis was used to identify predictors of 30-day mortality, intra- and post-operative complications, and disposition after discharge.
Results:Overall 30-day mortality was 15%. Predictors of mortality were congestive heart failure (OR 5.57), serum creatinine on the day of surgery (OR 3.39), acute MELD (OR 1.43), and delta MELD (OR 1.34). The most common complication was the need for transfusion (39%). Predictors of intraoperative complications were congestive heart failure (OR 9.32), coronary artery disease (OR 6.0), intra-abdominal surgery (OR 3.8), delta MELD (OR 1.23), and acute MELD (OR 1.19). Predictors of post-operative complications were intra-abdominal surgery (OR 3.92) and delta MELD (OR 1.22). 50% of patients needed transitional care. Negative predictors of being discharged to home were INR on the day of surgery (OR 0.05), and acute MELD (OR 0.78).
Conclusion:Delta MELD and acute MELD performed equally well as predictors of intra-operative complications and 30-day mortality. However, only acute MELD was associated with the need for transitional care and only delta MELD was associated with post-operative complications. The fact that the delta and acute MELD scores were predictive of different aspects of hospitalization suggests both may be of benefit in preparing for the logistics of emergency surgery in cirrhotic patients.
