MELD Score vs Child Score in Predicting the Outcome of Elective Abdominal Surgical Procedures in Patients with Cirrhosis

Abstract

Purpose: The aim of this study is to evaluate the outcome of patients with cirrhosis undergoing elective abdominal surgery and to compare the capacity of the Child-Turcotte-Pugh (CTP) and Model for End Stage Liver Disease (MELD) scores to predict that outcome. Methods: We conducted a chart review of patients with cirrhosis who underwent general anesthesia between January 1999 and December 2004 at Emory University Hospital and Emory Crawford Long Hospital. Patients with documented cirrhosis undergoing elective abdominal surgery were included. Patients undergoing liver transplantation or other surgical procedures involving the liver were excluded. Patients with evident extrahepatic cholestasis were excluded as well. Results: A total of 617 charts were screened. After the inclusion and exclusion criteria were applied, 66 procedures performed on 62 patients were identified. The mean MELD score was 9.4 ± 3.3, the mean CTP score was 7.3 ± 1.5. Twenty (30.3%) patients were classified as CTP class A, 40 (60.6%) as class B and 6 (9.1%) as class C. The most common procedures were hernia repair (21, 31.8%), cholecystectomy (17, 25.7%), and diagnostic laparoscopy/laparotomy (15, 22.8%). One patient (1.5%) died of pneumonia in the postoperative period. Signs of decompensated liver disease (hepatic encephalopathy, new ascites, variceal hemorrhage) in the postoperative period were noted in 5 patients (7.6%). There was no statistically significant difference in the CTP or MELD scores between patients who developed signs of decompensation and those who did not. Nine patients (13.6%) developed postoperative transaminase elevation (at least twice the baseline value). The patients with postoperative transaminase elevation had a higher baseline MELD (12.3 ± 3.9 vs 9.1 ± 2.6, p = 0.004), but not a higher CTP score (7.7 ± 2.2 vs 7.4 ±1.5, p = 0.68). Conclusions: Our data suggests that elective abdominal procedures in patients with cirrhosis appear to be relatively safe, with a low risk of liver-related complications. The MELD score correlates better than the CTP score with postoperative transaminase elevation. This may reflect an acute injury to the liver in the perioperative period. More studies are needed to better define the roles of the CTP and MELD scores in predicting the outcome of elective surgical procedures in patients with cirrhosis.