Higher MELD scores correlate with adverse operative outcomes regardless of the presence of liver disease, but their impact on pancreatectomy outcomes remains undefined. We aimed to compare 30-day adverse postoperative outcomes of patients undergoing elective pancreatectomy stratified by MELD score.
Elective pancreatoduodenectomies (PDs) and distal pancreatectomies (DPs) were identified from the 2014–2016 ACS NSQIP Procedure Targeted Pancreatectomy Participant Use Data Files. Outcomes examined included mortality, cardiopulmonary complications, prolonged postoperative length-of-stay, discharge not-to-home, transfusion, POPF, CR-POPF, any complication, and serious complication. Outcomes were compared between MELD score strata (< 11 vs. ≥ 11) as established by the United Network for Organ Sharing (UNOS). Multivariable logistic regression models were constructed to examine the risk-adjusted impact of MELD score on outcomes.
A total of 7580 PDs and 3295 DPs had evaluable MELD scores. Of these, 1701 PDs and 223 DPs had a MELD score ≥ 11. PDs with MELD ≥ 11 exhibited higher risk for mortality (OR = 2.07, p < 0.001), discharge not-to-home (OR = 1.26, p = 0.005), and transfusion (OR = 1.7, p < 0.001). DP patients with MELD ≥ 11 demonstrated prolonged LOS (OR = 1.75, p < 0.001), discharge not-to-home (OR = 1.83, p = 0.01), and transfusion (OR = 2.78, p < 0.001). In PD, MELD ≥ 11 was independently predictive of 30-day mortality (OR = 1.69, p = 0.007) and transfusion (OR = 1.55, p < 0.001). In DP, MELD ≥ 11 was independently predictive of prolonged LOS (OR = 1.42, p = 0.026) and transfusion (OR = 2.3, p < 0.001).
A MELD score ≥ 11 is associated with a near twofold increase in the odds of mortality following pancreatoduodenectomy. The MELD score is an objective assessment that aids in risk-stratifying patients undergoing pancreatectomy.
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Chu CK, Mazo AE, Sarmiento JM, Staley CA, Adsay NV, Umpierrez GE et al. Impact of diabetes mellitus on perioperative outcomes after resection for pancreatic adenocarcinoma. J Am Coll Surg. 2010;210(4):463–73. doi:https://doi.org/10.1016/j.jamcollsurg.2009.12.029.
Greenblatt DY, Kelly KJ, Rajamanickam V, Wan Y, Hanson T, Rettammel R et al. Preoperative factors predict perioperative morbidity and mortality after pancreaticoduodenectomy. Ann Surg Oncol. 2011;18(8):2126–35. doi:https://doi.org/10.1245/s10434-011-1594-6.
House MG, Fong Y, Arnaoutakis DJ, Sharma R, Winston CB, Protic M et al. Preoperative predictors for complications after pancreaticoduodenectomy: impact of BMI and body fat distribution. J Gastrointest Surg. 2008;12(2):270–8. doi:https://doi.org/10.1007/s11605-007-0421-7.
Kelly KJ, Greenblatt DY, Wan Y, Rettammel RJ, Winslow E, Cho CS et al. Risk stratification for distal pancreatectomy utilizing ACS-NSQIP: preoperative factors predict morbidity and mortality. J Gastrointest Surg. 2011;15(2):250–9, discussion 9-61. doi:https://doi.org/10.1007/s11605-010-1390-9.
Lillemoe KD, Kaushal S, Cameron JL, Sohn TA, Pitt HA, Yeo CJ. Distal pancreatectomy: indications and outcomes in 235 patients. Ann Surg. 1999;229(5):693–8; discussion 8-700.
Lau T, Ahmad J. Clinical applications of the Model for End-Stage Liver Disease (MELD) in hepatic medicine. Hepat Med. 2013;5:1–10. doi:https://doi.org/10.2147/HMER.S9049.
Nicoll A. Surgical risk in patients with cirrhosis. J Gastroenterol Hepatol. 2012;27(10):1569–75. doi:https://doi.org/10.1111/j.1440-1746.2012.07205.x.
Child CG, Turcotte JG. Surgery and portal hypertension. Major Probl Clin Surg. 1964;1:1–85.
Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg. 1973;60(8):646–9.
Malinchoc M, Kamath PS, Gordon FD, Peine CJ, Rank J, ter Borg PC. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology. 2000;31(4):864–71. doi:https://doi.org/10.1053/he.2000.5852.
Kamath PS, Wiesner RH, Malinchoc M, Kremers W, Therneau TM, Kosberg CL et al. A model to predict survival in patients with end-stage liver disease. Hepatology. 2001;33(2):464–70. doi:https://doi.org/10.1053/jhep.2001.22172.
Forman LM, Lucey MR. Predicting the prognosis of chronic liver disease: an evolution from child to MELD. Mayo End-stage Liver Disease. Hepatology. 2001;33(2):473–5. doi:https://doi.org/10.1053/jhep.2001.22481.
Said A, Williams J, Holden J, Remington P, Gangnon R, Musat A et al. Model for end stage liver disease score predicts mortality across a broad spectrum of liver disease. J Hepatol. 2004;40(6):897–903. doi:https://doi.org/10.1016/j.jhep.2004.02.010.
Wiesner R, Edwards E, Freeman R, Harper A, Kim R, Kamath P et al. Model for end-stage liver disease (MELD) and allocation of donor livers. Gastroenterology. 2003;124(1):91–6. doi:https://doi.org/10.1053/gast.2003.50016.
Casadaban LC, Gabra MG, Parvinian A, Minocha J, Knuttinen MG, Bui JT et al. Impact of transjugular intrahepatic portosystemic shunt creation on intermediate-term model for end-stage liver disease score progression. Transplant Proc. 2014;46(5):1384–8. doi:https://doi.org/10.1016/j.transproceed.2013.12.053.
Jacob M, Copley LP, Lewsey JD, Gimson A, Toogood GJ, Rela M et al. Pretransplant MELD score and post liver transplantation survival in the UK and Ireland. Liver Transpl. 2004;10(7):903–7. doi:https://doi.org/10.1002/lt.20169.
Lange EO, Jensen CC, Melton GB, Madoff RD, Kwaan MR. Relationship between model for end-stage liver disease score and 30-day outcomes for patients undergoing elective colorectal resections: an American college of surgeons-national surgical quality improvement program study. Dis Colon Rectum 2015;58(5):494–501. doi:https://doi.org/10.1097/DCR.0000000000000358.
Lopez-Delgado JC, Esteve F, Javierre C, Ventura JL, Manez R, Farrero E et al. Influence of cirrhosis in cardiac surgery outcomes. World J Hepatol. 2015;7(5):753–60. doi:https://doi.org/10.4254/wjh.v7.i5.753.
Millwala F, Nguyen GC, Thuluvath PJ. Outcomes of patients with cirrhosis undergoing non-hepatic surgery: risk assessment and management. World J Gastroenterol. 2007;13(30):4056–63.
Minhem MA, Sarkis SF, Safadi BY, Fares SA, Alami RS. Comparison of Early Morbidity and Mortality Between Sleeve Gastrectomy and Gastric Bypass in High-Risk Patients for Liver Disease: Analysis of American College of Surgeons National Surgical Quality Improvement Program. Obes Surg. 2018;28(9):2844–51. doi:https://doi.org/10.1007/s11695-018-3259-z.
Morimoto N, Okada K, Okita Y. The model for end-stage liver disease (MELD) predicts early and late outcomes of cardiovascular operations in patients with liver cirrhosis. Ann Thorac Surg. 2013;96(5):1672–8. doi:https://doi.org/10.1016/j.athoracsur.2013.06.007.
Northup PG, Wanamaker RC, Lee VD, Adams RB, Berg CL. Model for End-Stage Liver Disease (MELD) predicts nontransplant surgical mortality in patients with cirrhosis. Ann Surg. 2005;242(2):244–51.
Causey MW, Nelson D, Johnson EK, Maykel J, Davis B, Rivadeneira DE et al. 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. Am J Surg. 2014;207(4):520–6. doi:https://doi.org/10.1016/j.amjsurg.2013.06.008.
Hedrick TL, Swenson BR, Friel CM. Model for End-stage Liver Disease (MELD) in predicting postoperative mortality of patients undergoing colorectal surgery. Am Surg. 2013;79(4):347–52.
Kantor O, Talamonti MS, Pitt HA, Vollmer CM, Riall TS, Hall BL et al. Using the NSQIP Pancreatic Demonstration Project to Derive a Modified Fistula Risk Score for Preoperative Risk Stratification in Patients Undergoing Pancreaticoduodenectomy. J Am Coll Surg. 2017;224(5):816–25. doi:https://doi.org/10.1016/j.jamcollsurg.2017.01.054.
Kantor O, Pitt HA, Talamonti MS, Roggin KK, Bentrem DJ, Prinz RA et al. Minimally invasive pancreatoduodenectomy: is the incidence of clinically relevant postoperative pancreatic fistula comparable to that after open pancreatoduodenectomy? Surgery. 2018;163(3):587–93. doi:https://doi.org/10.1016/j.surg.2017.12.001.
del Olmo JA, Flor-Lorente B, Flor-Civera B, Rodriguez F, Serra MA, Escudero A et al. Risk factors for nonhepatic surgery in patients with cirrhosis. World J Surg. 2003;27(6):647–52. doi:https://doi.org/10.1007/s00268-003-6794-1.
Venkat R, Puhan MA, Schulick RD, Cameron JL, Eckhauser FE, Choti MA et al. Predicting the risk of perioperative mortality in patients undergoing pancreaticoduodenectomy: a novel scoring system. Arch Surg. 2011;146(11):1277–84. doi:https://doi.org/10.1001/archsurg.2011.294.
Are C, Afuh C, Ravipati L, Sasson A, Ullrich F, Smith L. Preoperative nomogram to predict risk of perioperative mortality following pancreatic resections for malignancy. J Gastrointest Surg. 2009;13(12):2152–62. doi:https://doi.org/10.1007/s11605-009-1051-z.
Hill JS, Zhou Z, Simons JP, Ng SC, McDade TP, Whalen GF et al. A simple risk score to predict in-hospital mortality after pancreatic resection for cancer. Ann Surg Oncol. 2010;17(7):1802–7. doi:https://doi.org/10.1245/s10434-010-0947-x.
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Al Abbas, A.I., Borrebach, J.D., Bellon, J. et al. Does Preoperative MELD Score Predict Adverse Outcomes Following Pancreatic Resection: an ACS NSQIP Analysis. J Gastrointest Surg 24, 2259–2268 (2020). https://doi.org/10.1007/s11605-019-04380-0
- Distal pancreatectomy
- Liver disease