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MELD-Na Score Is Associated With 30-Day Morbidity and Mortality Among Patients Undergoing Emergent Colon Resection
Ann-Kristin U. Friedrich*1,2, Kevin P. Baratta1, J. Alexander Palesty2, Mitchell A. Cahan1
1Surgery, University of Massachusetts Medical School, Worcester, MA; 2Surgery, Saint Mary's Hospital, Waterbury, CT
Background. The Model for End-Stage Liver Disease Sodium Model (MELD-Na) is a scoring system used to predict mortality for patients awaiting liver transplantation utilizing bilirubin, international normalized ratio, serum creatinine and sodium. It has previously been shown to be associated with increased complication rates after elective resection for colon cancer. The aim of this study was to determine if MELD-Na scores could be used to predict morbidity and mortality associated with emergent colon resection for all indications in patients with and without underlying liver disease.
Methods. The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Database was used to identify patients who had undergone emergent colon resection from 2005 to 2012. Logistic regression modelling was used to identify the impact of MELD-Na score on 30-day morbidity and mortality.
Results. A total of 23.030 patients who had undergone emergent colectomy were identified in the database. Average age was 64.1 years. The majority of patients were female (53.7%). Most common indication for colectomy included diverticulitis (29.8%), perforation (21.7%), ischemic colitis (14.0%), colorectal cancer (13.4%) and volvulus (7.9%). A total of 12.281 patients had experienced complications (53.3%), overall 30-day mortality was 16% (3.683 patients). Pre-operative MELD-Na scores were available for 14.620 patients (63.5%). After adjusting for age, sex, ASA classification, BMI, existing liver disease and wound classification, each point increase in MELD-Na score was associated with a 3.1% increased risk of complication and a 5.4% increased risk of death.
Conclusion. MELD-Na scores can be used to stratify risk of post-operative morbidity and mortality among patients undergoing emergent colectomy and may help to identify and proactively manage high risk patients.
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