1. MELD-Na (the new MELD) and peri-operative outcomes in emergency surgery.
- Author
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Godfrey EL, Kueht ML, Rana A, and Awad S
- Subjects
- Biomarkers blood, Female, Humans, Incidence, Liver Cirrhosis mortality, Liver Cirrhosis surgery, Male, Retrospective Studies, Risk Factors, Survival Rate trends, Texas epidemiology, Digestive System Surgical Procedures adverse effects, Emergencies, Intraoperative Complications epidemiology, Liver Cirrhosis blood, Postoperative Complications epidemiology, Sodium blood
- Abstract
Background: The new Model for End-Stage Liver Disease includes serum sodium (MELD-Na). To evaluate its predictive power in non-transplant surgery, we analyzed emergency surgery outcomes of cirrhotic patients, hypothesizing that negative outcomes could be associated with discrete MELD-Na score thresholds., Methods: Retrospective chart review was conducted of patients with cirrhosis undergoing emergency surgery at our institution from 2001 to 2013 (n = 85). Risk thresholds and predictors of peri-operative outcomes were identified using univariate and multivariate regression., Results: MELD-Na scores of 19, 17, and 12 were identified as predictors of 30-day mortality (OR = 3.44), post-operative complications (OR = 3.08), and discharge to home (inverse relationship, OR = 0.31). Post-operative complications were independent negative predictors of discharge to home (OR = 0.21)., Conclusion: Although emergency surgery in patients with cirrhosis can be life-saving, knowledge of the significant peri-operative risk should drive decision-making, informed by the increased risk associated with these score thresholds. Further study is needed to establish definitive MELD-Na thresholds., (Copyright © 2018 Elsevier Inc. All rights reserved.)
- Published
- 2018
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