K. Coakley1, S. Sarasani1, T. Prasad1, S. Steele2, I. Paquette3, B. Heniford1, B. Davis1 2Case Western Reserve University School Of Medicine,Department Of Surgery,Cleveland, OH, USA 3University Of Cincinnati,Department Of Surgery,Cincinnati, OH, USA 1Carolinas Medical Center,GI And Minimally Invasive Surgery,Charlotte, NC, USA
Introduction:
In patients with cirrhosis awaiting liver transplantation The Model for End-Stage Liver Disease Sodium Model (MELD-Na) is extensively studied. Because of the simplicity of the scoring system, there has been interest in applying MELD-Na to predict patient outcomes in the non-cirrhotic surgical patient, and has been shown to predict postoperative morbidity and mortality after elective colon cancer surgery. Our aim was to identify the utility of MELD-Na to predict anastomotic leak in all types of elective colorectal cases.
Methods:
The ACS NSQIP Targeted Colectomy database was queried (2012 – 201) for all elective colorectal procedures in patients without ascites. Leak rates were compared by MELD-Na score using Chi-square tests and multivariate logistic regression analysis.
Results:
We identified 44,540 elective colorectal cases (mean age, 60.5 years ±14.4, mean BMI 28.8±6.6, 52% female), of which 70% were colectomy and 30% proctectomy. Laparoscopic approach accounted for 64.72% while 35.3% were open. The overall complication and mortality rates were 21% and 0.7%, respectively, with a total anastomotic leak rate of 3.4%. Overall, 98% had a preoperative MELD-Na score between 10-20. Incremental increases in MELD-Na score (10-14, 15-19 and ≥20) were associated with an increased leak rate, specifically in proctectomies (3.9% vs 5.1% vs10.7% p<0.028). MELD-Na score ≥20 had an increased leak rate when compared to those with MELD-Na 10-14 (OR 1.627; 95% CI (1.015, 2.607). A MELD-Na increase from 10-14 into 15-19 increases overall mortality (OR 5.22; 95% CI 3.55, 7.671). In all elective colorectal procedures, for every one-point increase in MELD-Na score, anastomotic leak (OR 1.04 95% CI (1.006, 1.07), mortality (OR 1.24; 95% CI, (1.20, 1.27) and overall complications (OR 1.10; 95% CI (1.09,1.12) increased. MELD-Na was an independent predictor of anastomotic leak in proctectomies, when controlling for gender, steroid use, smoking, approach, operative time, preoperative chemotherapy and Crohns Disease (OR 1.06, 95% CI (1.002, 1.122)).
Conclusion:
MELD-Na is an independent predictor of anastomotic leak in proctectomies. Anastomotic leak risk increases with increasing MELD-Na in elective colorectal resections, as does 30-day mortality and overall complication rate. As MELD-Na score increases to above 20, restorative proctectomy has a 10% rate of anastomotic leak.
