K. A. Schlosser1, A. M. Kao1, M. R. Arnold1, J. Otero1, T. Prasad1, A. E. Lincourt1, K. R. Kasten1, V. A. Augenstein1, B. R. Davis1, B. T. Heniford1, P. D. Colavita1 1Carolinas Medical Center,Division Of Gastrointestinal And Minimally Invasive Surgery,Charlotte, NC, USA
Introduction:
In patients with cirrhosis, the Model for End-Stage Liver Disease Sodium (MELD-Na) is validated as a predictor for transplant and non-transplant surgical outcomes. MELD-Na may also predict patient outcomes in the non-cirrhotic surgical patient. MELD-Na has been demonstrated to predict postoperative morbidity and mortality after elective colectomy, including anastomotic leak. The aim of this study is to apply MELD-Na to predict postoperative complications following elective ventral hernia repair.
Methods:
The ACS NSQIP database was queried (2005-2014) for all elective ventral hernia procedures in patients without ascites or esophageal varices. Postoperative complications and outcomes were compared by MELD-Na score using Chi-square tests and multivariate logistic regression analysis, controlling for age, gender, smoking, steroid use, wound class, and other comorbidities.
Results:
A total of 36,267 elective hernia repairs were identified with mean age 57.9 ± 13.7 years, BMI 33.0 ± 8.7, and 43.7% performed in males. 29.8% of all patients had a preoperative MELD-Na score between 10-20. The overall major, minor, and wound complication rates were 9%, 10.9%, and 6% respectively. 70.2% were performed open (OVHR). In multivariate analysis of OHVR, incremental increases in MELD-Na score (10-14, 15-19, and ≥ 20) were independently associated with worse outcomes when compared to MELD-Na < 10. MELD-Na 10 – 14 predicted increased 30-day mortality (OR 1.663; CI 1.10-2.52), return to the operating room (OR 1.20; CI 1.00-1.44), major complications (OR 1.27; CI 1.12-1.44), and minor complications (OR 1.30; CI 1.15-1.46). OVHR with MELD-Na 15-19 had higher odds for 30-day mortality (OR 2.89; CI 1.73-4.81), return to the OR (OR 1.38; CI 1.03-1.85), major complications (OR 1.59; CI 1.31-1.92), and minor complications (OR 1.49 CI 1.23-1.79). In laparoscopic repair (LVHR), there were increased major complications in patients with MELD-Na 15-19 (OR 2.38; CI 1.41-4.04). With OVHR and LVHR grouped, elevated MELD-Na scores were associated with increases in 30-day mortality, return to the OR, and major and minor complications. Higher MELD-Na scores were associated with increased rates of several poor outcomes (see table); major complications increased by 28% for MELD Na of 10-14 (OR 1.28; CI 1.138-1.144), 59% for MELD-Na of 15-19 (OR 1.59; CI 1.31-1.94), and over 100% for MELD-Na ≥20 (OR 2.13; CI 1.51-3.00).
Conclusion:
MELD-Na is independently associated with increased postoperative complications and 30-day mortality in elective laparoscopic and open ventral hernia repair. Preoperative MELD-Na screening in non-cirrhotic patients should be considered.
