Relationship Between Model for End-Stage Liver Disease Score and 30-Day Outcomes For Patients Undergoing Elective Colorectal Resections: An American College of Surgeons-National Surgical Quality Improvement Program Study
Department of Surgery, University of Minnesota, Minneapolis, Minnesota
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BACKGROUND:Patients with liver disease face significant risk of complications and death when considering elective colorectal resection for benign or malignant indications.OBJECTIVE:We sought to determine the relationship between Model of End-Stage Liver Disease score and 30-day outcomes in patients undergoing elective colorectal resections.DESIGN:This was a retrospective cohort study.SETTINGS:The study included hospitals participating in the National Surgical Quality Improvement Program.PATIENTS:Adult patients who underwent elective colorectal resection from 2005 to 2011 were identified from the National Surgical Quality Improvement Program database. Patients missing laboratory values necessary to calculate the Model of End-Stage Liver Disease score were excluded (61% of 81,346 patients identified).MAIN OUTCOME MEASURES:Differences in patient- and disease-related characteristics by Model of End-Stage Liver Disease categories were assessed with χ2 analyses. Thirty-day mortality and major morbidity were examined using logistic regression.RESULTS:Of 31,950 patients undergoing elective colorectal resections (14% including proctectomy), most (60%) were performed for colon or rectal cancer; other benign indications included diverticulitis (20%), polyp (10%), and IBD (10%). A total of 58% of patients had a Model of End-Stage Liver Disease score of ≥7. Increasing scores were associated with older age; higher BMI; higher ASA class; lower albumin level; and higher incidence of diabetes mellitus, pulmonary and cardiac disease, hypertension, and dependent functional status. In univariate analysis, patients with higher scores had a greater risk of 30-day mortality (score = 6 (0.69%); 7–11 (1.62%); 11–15 (4.52%); >15, (5.01%); p < 0.0001). After controlling for other comorbidities, Model of End-Stage Liver Disease score remained a significant predictor of 30-day mortality, major complications, and respiratory complications.LIMITATIONS:This was a retrospective analysis of administrative data, limiting some access to clinically relevant data.CONCLUSIONS:Consistent with previous reports, patients with higher Model of End-Stage Liver Disease scores have a significantly higher risk of death and major morbidity in the 30 days after elective colorectal resection (see Video, Supplemental Digital Content, http://links.lww.com/DCR/A180).