Predictors of mortality in cirrhotic patients undergoing extrahepatic surgery: comparison of Child-Turcotte-Pugh and model for end-stage liver disease-based indices.

Abstract

BACKGROUND:

Underlying liver cirrhosis is associated with high morbidity and mortality after surgery. Previous studies have reported conflicting results about the value of Child-Turcotte-Pugh (CTP) and model for end-stage liver disease (MELD) scores as predictors of post-operative mortality. This study was designed to compare the capacities of CTP, MELD and MELD-based indices in predicting mortality for patients with liver cirrhosis who underwent elective extrahepatic surgery.

METHODS:

The medical records of 79 patients with liver cirrhosis who underwent elective extrahepatic surgery under general anaesthesia from December 2000 to December 2009 were reviewed retrospectively.

RESULTS:

The median follow-up period was 21 months, and the mortality rate was 24.1% (n = 19). Among the 19 mortalities, nine (11.4%) occurred while the patient was hospitalized after surgery. Intraoperative transfusion amount (≥700 mL; odds ratio 6.294, P = 0.004) and the integrated MELD score (≥34; odds ratio 6.654, P = 0.007) were significantly correlated with post-operative mortality. CTP score (hazard ratio 1.575, P = 0.012) was significantly correlated with overall mortality.

CONCLUSIONS:

Integrated MELD may be a more accurate predictor of operative mortality in cirrhotic patients undergoing extrahepatic surgery than CTP and other MELD-Na based indices. However, overall mortality may be reflected more accurately by CTP score. Further large-scale study will be needed to validate this result.

• Authors: Dong Hyun Kim, Sung Hoon Kim, Kyung Sik Kim, Woo Jung Lee, Nam Kyu Kim, Sung Hoon Noh, Choong Bai Kim
• Journal: ANZ journal of surgery (ANZ J Surg) Vol. 84 Issue 11 Pg. 832-6 (Nov 2014) ISSN: 1445-2197 [Electronic] Australia
• PMID: 23647879 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2013 The Authors. ANZ Journal of Surgery © 2013 Royal Australasian College of Surgeons.

Topics

• Adult
• Aged
• Aged, 80 and over
• Elective Surgical Procedures (methods)
• End Stage Liver Disease (diagnosis, etiology, mortality)
• Female
• Follow-Up Studies
• Health Status Indicators
• Humans
• Intraoperative Period
• Liver Cirrhosis (complications, mortality)
• Male
• Middle Aged
• Postoperative Period
• Predictive Value of Tests
• Prognosis
• Republic of Korea (epidemiology)
• Retrospective Studies
• Risk Assessment (methods)
• Risk Factors
• Severity of Illness Index
• Survival Rate (trends)
• Young Adult