Predictors of mortality in cirrhotic patients undergoing extrahepatic surgery: comparison of Child-Turcotte-Pugh and model for end-stage liver disease-based indices.

BACKGROUND

Underlying liver cirrhosis is associated with high morbidity and mortality after surgery. Previous studies have reported conflicting results about the value of Child-Turcotte-Pugh (CTP) and model for end-stage liver disease (MELD) scores as predictors of post-operative mortality. This study was designed to compare the capacities of CTP, MELD and MELD-based indices in predicting mortality for patients with liver cirrhosis who underwent elective extrahepatic surgery.

METHODS

The medical records of 79 patients with liver cirrhosis who underwent elective extrahepatic surgery under general anaesthesia from December 2000 to December 2009 were reviewed retrospectively.

RESULTS

The median follow-up period was 21 months, and the mortality rate was 24.1% (n = 19). Among the 19 mortalities, nine (11.4%) occurred while the patient was hospitalized after surgery. Intraoperative transfusion amount (≥700 mL; odds ratio 6.294, P = 0.004) and the integrated MELD score (≥34; odds ratio 6.654, P = 0.007) were significantly correlated with post-operative mortality. CTP score (hazard ratio 1.575, P = 0.012) was significantly correlated with overall mortality.

CONCLUSIONS

Integrated MELD may be a more accurate predictor of operative mortality in cirrhotic patients undergoing extrahepatic surgery than CTP and other MELD-Na based indices. However, overall mortality may be reflected more accurately by CTP score. Further large-scale study will be needed to validate this result.