Department of Surgery, Yale School of Medicine, New Haven, CT.
Section of Surgical Outcomes and Epidemiology, Department of Surgery, Yale School of Medicine, New Haven, CT.
Surgery. 2018 Aug;164(2):233-237. doi: 10.1016/j.surg.2018.03.005. Epub 2018 Apr 26.
Ascites and the Model for End-Stage Liver Disease score have both been shown to independently correlate with surgical morbidity and mortality. We evaluated if incorporating the presence of ascites changed postoperative risk as assessed by the Model for End-Stage Liver Disease score.
Data originated from the National Surgical Quality Improvement Program database from 2005-2014. Patients undergoing hernia repair, adhesiolysis, and cholecystectomy were included. Univariate analysis and logistic regression stratified by Model for End-Stage Liver Disease score and presence of ascites was performed.
A total of 30,391 patients were analyzed. When compared to low Model for End-Stage Liver Disease stratum without ascites, the presence of ascites predicted increased risk for complications (low Model for End-Stage Liver Disease with ascites odds ratio 3.22, 95% confidence interval [2.00-5.18], moderate Model for End-Stage Liver Disease with ascites odds ratio 3.70, 95% confidence interval [2.64-5.19], high Model for End-Stage Liver Disease with ascites odds ratio 6.38, 95% confidence interval [4.39-9.26]). These findings hold true for mortality as well (low Model for End-Stage Liver Disease with ascites odds ratio 9.40 95% confidence interval [3.53-25.01], moderate Model for End-Stage Liver Disease with ascites odds ratio 15.24 95% confidence interval [8.17-28.45], high Model for End-Stage Liver Disease with ascites odds ratio 28.56 95% confidence interval [15.43-52.88]).
Ascites increased the risk of morbidity and mortality across multiple general surgery operations. Model for End-Stage Liver Disease may underestimate surgical risk in patients with ascites. Predictive models inclusive of ascites may more accurately predict the perioperative risk of these complex patients.
腹水和终末期肝病模型评分都被证明与手术发病率和死亡率独立相关。我们评估了腹水的存在是否改变了终末期肝病模型评分评估的术后风险。
数据来源于 2005 年至 2014 年国家手术质量改进计划数据库。纳入疝修补术、粘连松解术和胆囊切除术患者。进行了单变量分析和按终末期肝病模型评分和腹水存在分层的逻辑回归分析。
共分析了 30391 例患者。与无腹水的低终末期肝病模型分层相比，腹水的存在预测并发症风险增加（低终末期肝病模型伴腹水比值比 3.22，95%置信区间[2.00-5.18]，中终末期肝病模型伴腹水比值比 3.70，95%置信区间[2.64-5.19]，高终末期肝病模型伴腹水比值比 6.38，95%置信区间[4.39-9.26]）。这些发现也适用于死亡率（低终末期肝病模型伴腹水比值比 9.40，95%置信区间[3.53-25.01]，中终末期肝病模型伴腹水比值比 15.24，95%置信区间[8.17-28.45]，高终末期肝病模型伴腹水比值比 28.56，95%置信区间[15.43-52.88]）。
腹水增加了多种普外科手术发病率和死亡率的风险。终末期肝病模型可能低估了腹水患者的手术风险。包括腹水的预测模型可能更准确地预测这些复杂患者的围手术期风险。
