| Title |
Model for End‐Stage Liver Disease Underestimates Morbidity and Mortality in Patients with Ascites Undergoing Colectomy
|
|---|---|
| Published in |
World Journal of Surgery, March 2018
|
| DOI | 10.1007/s00268-018-4591-0 |
| Pubmed ID | |
| Authors |
Matthew M. Fleming, Fangfang Liu, Yawei Zhang, Kevin Y. Pei |
| Abstract |
The Model for End-Stage Liver Disease (MELD) score and ascites correlate with surgical morbidity and mortality. However, the MELD score does not account for ascites. We sought to evaluate whether the MELD score accurately risk stratifies patients with ascites. We analyzed the American College of Surgeons National Surgical Quality Improvement Program (2005-2014) to examine the risk-adjusted morbidity and mortality of cirrhotic patients with and without ascites undergoing colectomy for diverticulitis. Patients were stratified by MELD score, and the presence of ascites and outcomes were compared between patients with and without ascites to the reference group of low MELD and no ascites. Multivariable logistic regression was used to control for demographic factors and comorbidities. A total of 16,877 colectomies were analyzed. For each MELD stratum, patients with ascites have increased risk of complications compared to those without ascites (P < 0.05 unless indicated): low MELD ascites OR 1.13, P = 0.69, moderate MELD no ascites OR 1.37, moderate MELD ascites OR 2.06, high MELD no ascites OR 1.93, and high MELD ascites OR 3.54. These trends hold true for mortality: low MELD ascites OR 2.91, P = 0.063, moderate MELD no ascites OR 1.47, moderate MELD ascites OR 5.62, high MELD no ascites OR 3.04, and high MELD ascites OR 9.91. Ascites predicts an increased risk for postoperative morbidity and mortality for cirrhotic patients undergoing colectomy for all MELD classifications. These findings suggest that the MELD score significantly underestimates postoperative risk as it does not account for ascites. |
X Demographics
The data shown below were collected from the profiles of 4 X users who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| United States | 1 | 25% |
| Unknown | 3 | 75% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Practitioners (doctors, other healthcare professionals) | 3 | 75% |
| Members of the public | 1 | 25% |
Mendeley readers
The data shown below were compiled from readership statistics for 13 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 13 | 100% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Student > Master | 2 | 15% |
| Student > Postgraduate | 2 | 15% |
| Researcher | 2 | 15% |
| Student > Doctoral Student | 1 | 8% |
| Other | 1 | 8% |
| Other | 0 | 0% |
| Unknown | 5 | 38% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 7 | 54% |
| Pharmacology, Toxicology and Pharmaceutical Science | 1 | 8% |
| Unknown | 5 | 38% |
Attention Score in Context
This research output has an Altmetric Attention Score of 2. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 02 July 2018.
All research outputs
#14,378,457
of 23,028,364 outputs
Outputs from World Journal of Surgery
#2,793
of 4,262 outputs
Outputs of similar age
#189,798
of 333,763 outputs
Outputs of similar age from World Journal of Surgery
#65
of 89 outputs
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