The model for end-stage liver disease predicts outcomes in patients undergoing cholecystectomy

Abstract

Background

The magnitude of risk for patients undergoing cholecystectomy with high model for end-stage liver disease (MELD) scores is poorly understood.

Methods

The American College of Surgeons National Surgical Quality Improvement Program database from 2005 to 2013 was used to study patients undergoing cholecystectomy. Patients were excluded if they had choledocholithiasis or preoperative dialysis. Bivariate data analysis was performed and logistic regression modeling was conducted to calculate risk-adjusted 30-day outcomes.

Results

A total of 63,464 patients were included in the study. Unadjusted mortality significantly increased as the MELD score increased in the laparoscopic (MELD = 6–10, 0.2%; 11–15, 1.1%; 16–20, 3.2%; >20, 5.8%) and open groups (MELD = 6–10, 1.5%; 11–15, 3.7%; 16–20, 8.6%; >20, 17.9%) (p-value <0.001 for both). Unadjusted morbidity also increased with MELD score increases in the laparoscopic (MELD = 6–10, 3.8%; 11–15, 9.9%; 16–20, 16.3%; >20, 22.8%) and open groups (MELD = 6–10, 18.7%; 11–15, 28.2%; 16–20, 40.7%; >20, 57.8%) (p-value <0.001 for both). Patients with ascites and high MELD scores had higher rates of mortality (laparoscopic, MELD > 20, 33.3%; open, MELD > 20, 48.5%) and morbidity (laparoscopic, MELD > 20, 66.7%; open, MELD > 20, 75.8%) across all MELD scores. After adjustment, MELD score acted as a progressive and independent predictor of morbidity and mortality.

Conclusions

The MELD score is an objective and easy to calculate scoring system that independently predicts postoperative morbidity and mortality in patients undergoing cholecystectomy. Patients with ascites have substantially worse outcomes across all MELD scores. Open cholecystectomy is associated with significantly more morbidity and mortality than laparoscopic cholecystectomy across all MELD groups.

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