2005 Abstracts: Can the MELD Score Predict Peri-Operative Morbidity for Patients with Liver Cirrhosis Undergoing Laparoscopic Cholecystectomy?
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Can the MELD Score Predict Peri-Operative Morbidity for Patients with Liver Cirrhosis Undergoing Laparoscopic Cholecystectomy?
Juliane Bingener, Dept of Surgery, UTHSCSA, San Antonio, TX; Diane Esker, UTHSCSA, Dept of Surgery, San Antonio, TX; Kenneth R. Sirinek, Deptof Surgery, UTHSCSA, San Antonio, TX; Alejandro Mejia, Dept of Surgery, UTHSCSA, San Antonio, TX
Introduction: The Model for End Stage Liver Disease (MELD) score is a mortality predictor in patients awaiting liver transplantation. Here we evaluate the ability of the MELD score to predict the peri-operative morbidity for laparoscopic cholecystectomy in patients with cirrhosis.
Methods: From 3/1991 to 2/2004 data of all patients undergoing laparoscopic cholecystectomy were prospectively entered into a database. Data of patients with a secondary diagnosis of liver cirrhosis were reviewed. The MELD score was calculated by: (0.957 x ln creat + 0.378 x ln bili + 1.12 x ln INR + 0.643) x 10. It was correlated with outcome variables. Morbidity was classified into stages as described by Clavien. The study was considered exempt by the IRB. Results: Of 7,859 patients undergoing laparoscopic cholecystectomy, 99 patients (1.3%) were diagnosed with liver cirrhosis, 44 women and 55 men. The mean age was 55 years (range 28 to 92). Operative indications were chronic cholecystitis in 70%, acute cholecystitis in 17%, biliary pancreatitis in 11%, biliary dyskinesia in 2% of the patients. Eleven patients were converted to open cholecystectomy (11%). The mortality rate was 2%, the overall morbidity was 28%. More than half of the complications were serious (>Clavien Class 2b). 11/55 men had a complication (20%), 3/44 women (7%) (p=0.12). Laboratory values on 55 patients were available to calculate a MELD score. The mean MELD score was 11 (range 6 – 24). There was no significant difference in MELD scores between men and women, alcoholic and non-alcoholic liver cirrhosis. Table: Complication rate relative to MELD score
Conclusion: Patients with liver cirrhosis undergoing laparoscopic cholecystectomy have a substantial risk for peri-operative morbidity. The MELD score appears useful to for risk stratification but requires further investigation.
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