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MELD SCORE IS PREDICTIVE OF POSTOPERATIVE MORBIDITY AND MORTALITY IN PATIENTS WITH ACUTE APPENDICITIS UNDERGOING APPENDECTOMY: NSQIP DATA ANALYSIS
Fady Daniel
*1, Ali Chaitou
1, Maha Makki
2, Mariam Baydoun
1, Hani Tamim
2,3, Mohamad Khalife
41Division of Gastroenterology and Hepatology, American University of Beirut Medical Center, Beirut, Lebanon; 2Clinical Research Institute, American University of Beirut, Beirut, Lebanon; 3College of Medicine, Alfaisal University, Riyadh, Saudi Arabia; 4Department of General Surgery, American University of Beirut Medical Center, Beirut, Lebanon
Background: The Model for End-stage Liver Disease (MELD) score has been shown to be a valid predictive tool of postoperative risks for different types of surgeries after being restricted to liver transplantation eligibility assessment in cirrhotic patients. Knowing that appendectomy is one of the most common surgical procedures, our objective is to compare the impact of the three versions of the MELD score (1.0, 2.0, and 3.0) on the risk assessment of the 30-day postoperative morbidity and mortality in patients undergoing appendectomy for acute appendicitis.
Methods: The data of patients undergoing appendectomy for acute appendicitis was collected from the American College of Surgeons–National Surgical Quality Improvement Program (ACS–NSQIP) database from 2018 to 2022 using the Current Procedural Terminology (CPT) codes 44950, 44960, and 44970. The comparisons between the different MELD scores and the outcomes were performed using the chi-square test. To assess the discriminatory power of the MELD 1.0 vs. MELD 2.0 vs. MELD 3.0 for each outcome, the Receiver Operating Characteristics (ROC) curves were plotted, and the areas under the curve (AUC) were reported. The outcomes measured included 30-day mortality, wound infection, cardiac, respiratory, urinary, and central nervous system complications, thromboembolism, sepsis, bleeding, return to the operating room, and composite morbidity.
Results: A total of 121,207 patients were included, with a mean age of 45.31 ± 17.89 years, and of which 58495 (48.3%) are females. The majority, 102,895 (90.7%) patients underwent laparoscopic appendectomy, whereas 10599 (9.3%) had open appendectomy. The overall 30-day surgical mortality was 0.5% (567/121,207), and postoperative sepsis was observed in 5.8% (7063/121,20) of patients. The remaining postoperative outcomes are shown in Table 1. All the MELD score versions significantly predicted the outcomes independently of the surgical approach (laparoscopic/open appendectomy, simple/complicated appendicitis) with means of 8.21 ± 2.81, 9.01 ± 3.39, and 3.0 9.21 ± 3.26, for MELD 1.0, MELD 2.0, and MELD 3.0, respectively. MELD 3.0 noticeably outperformed its predecessors regarding all the outcomes (Figure 1). Patients having a score ? 11 had a higher prevalence of postoperative complications.
Conclusion: The MELD score in its three versions is a valid tool for 30-day morbidity and mortality risk assessment in patients undergoing appendectomy for acute appendicitis. MELD 3.0 score with a cutoff of 11 has proven to be superior to its predecessors concerning the risk assessment of appendectomy outcomes.
Figure 1. ROC curves comparing MELD 1.0, MELD 2.0, and MELD 3.0 for 30-day mortality (A) and sepsis (B).
Table 1. Postoperative morbidity and mortality outcomes of appendectomy.
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