Does Preoperative MELD Score Predict Adverse Outcomes Following Pancreatic Resection: an ACS NSQIP Analysis
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ORIGINAL ARTICLE
Does Preoperative MELD Score Predict Adverse Outcomes Following Pancreatic Resection: an ACS NSQIP Analysis Amr I. Al Abbas 1 & Jeffrey D. Borrebach 2 & Johanna Bellon 2 & Amer H. Zureikat 1,3 Received: 1 May 2019 / Accepted: 18 August 2019 # 2019 The Society for Surgery of the Alimentary Tract
Abstract Background Higher MELD scores correlate with adverse operative outcomes regardless of the presence of liver disease, but their impact on pancreatectomy outcomes remains undefined. We aimed to compare 30-day adverse postoperative outcomes of patients undergoing elective pancreatectomy stratified by MELD score. Methods Elective pancreatoduodenectomies (PDs) and distal pancreatectomies (DPs) were identified from the 2014–2016 ACS NSQIP Procedure Targeted Pancreatectomy Participant Use Data Files. Outcomes examined included mortality, cardiopulmonary complications, prolonged postoperative length-of-stay, discharge not-to-home, transfusion, POPF, CR-POPF, any complication, and serious complication. Outcomes were compared between MELD score strata (< 11 vs. ≥ 11) as established by the United Network for Organ Sharing (UNOS). Multivariable logistic regression models were constructed to examine the riskadjusted impact of MELD score on outcomes. Results A total of 7580 PDs and 3295 DPs had evaluable MELD scores. Of these, 1701 PDs and 223 DPs had a MELD score ≥ 11. PDs with MELD ≥ 11 exhibited higher risk for mortality (OR = 2.07, p < 0.001), discharge not-to-home (OR = 1.26, p = 0.005), and transfusion (OR = 1.7, p < 0.001). DP patients with MELD ≥ 11 demonstrated prolonged LOS (OR = 1.75, p < 0.001), discharge not-to-home (OR = 1.83, p = 0.01), and transfusion (OR = 2.78, p < 0.001). In PD, MELD ≥ 11 was independently predictive of 30-day mortality (OR = 1.69, p = 0.007) and transfusion (OR = 1.55, p < 0.001). In DP, MELD ≥ 11 was independently predictive of prolonged LOS (OR = 1.42, p = 0.026) and transfusion (OR = 2.3, p < 0.001). Conclusion A MELD score ≥ 11 is associated with a near twofold increase in the odds of mortality following pancreatoduodenectomy. The MELD score is an objective assessment that aids in risk-stratifying patients undergoing pancreatectomy. Keywords Pancreatectomy . Pancreatoduodenectomy . Distal pancreatectomy . Liver disease . MELD
Introduction Although mortality after pancreatic resection has decreased over the past decades, postoperative morbidity remains Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11605-019-04380-0) contains supplementary material, which is available to authorized users. * Amer H. Zureikat [email protected] 1
University of Pittsburgh Medical Center, Pittsburgh, PA, USA
2
The Wolff Center at UPMC, Pittsburgh, PA, USA
3
Division of GI Surgical Oncology, UPMC Pancreatic Cancer Center, University of Pittsburgh Medical Center, 5150 Centre Ave, Suite 421, Pittsburgh, PA 15232, USA
significant, with complication rates ranging from 20 to 65% for pancreatoduodenectomy and 28–31% for distal pancreatectomy.1–
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