Background & Aims
Current methods of predicting
risk of postoperative mortality in patients with
cirrhosis are suboptimal. The utility of the Model for
End-stage Liver Disease (MELD) in predicting mortality
after surgery other than liver transplantation is
unknown. The aim of this study was to determine
the risk factors for postoperative mortality in patients
with cirrhosis. Methods: Patients with cirrhosis
(N=772) who underwent major digestive (n=586), orthopedic
(n=107), or cardiovascular (n=79) surgery
were studied. Control groups of patients with cirrhosis
included 303 undergoing minor surgical procedures
and 562 ambulatory patients. Univariate and
multivariable proportional hazards analyses were
used to determine the relationship between risk factors
and mortality. Results: Patients undergoing
major surgery were at increased risk for mortality
up to 90 days postoperatively. By multivariable analysis,
only MELD score, American Society of Anesthesiologists
class, and age predicted mortality at 30
and 90 days, 1 year, and long-term, independently of
type or year of surgery. Emergency surgery was the
only independent predictor of duration of hospitalization
postoperatively. Thirty-day mortality ranged
from 5.7% (MELD score, <8) to more than 50%
(MELD score, >20). The relationship between MELD
score and mortality persisted throughout the 20-year
postoperative period. Conclusions: MELD score, age, and American Society of Anesthesiologists class can
quantify the risk of mortality postoperatively in patients
with cirrhosis, independently of the procedure
performed. These factors can be used in determining
operative mortality risk and whether elective surgical
procedures can be delayed until after liver
transplantation.
