Scientific paper
Child-Turcotte-Pugh versus MELD score as a predictor of outcome after elective and emergent surgery in cirrhotic patients

Presented at the 28th Annual Symposium of the Association of VA Surgeons, Richmond, Virginia, April 25–27, 2004
https://doi.org/10.1016/j.amjsurg.2004.07.034Get rights and content

Abstract

Background

Cirrhotic patients who present for elective and emergent surgery pose a formidable challenge for the surgeon because of the high reported morbidity and mortality. The Child-Turcotte-Pugh (CTP) score previously has been used to evaluate preoperative severity of liver dysfunction and to predict postoperative outcome. Recently, a more objective scoring classification, the model for end-stage liver disease (MELD), has been shown to predict accurately the 3-month mortality for cirrhotic patients awaiting transplantation. We sought to compare the CTP and MELD scores in predicting outcomes in cirrhotic patients undergoing surgical procedures requiring general anesthesia.

Methods

During the study period, 40 patients with a history of cirrhosis who required elective (E) or emergent (EM) surgical procedures under general anesthesia were reviewed (E = 24, EM = 16). The preoperative CTP and MELD scores were calculated and patient short- (30-day) and long-term (3-month) outcomes were recorded.

Results

There was a significant difference in the 1-month and 3-month mortality rates between the emergent and elective groups (EM group: 1 mo = 19%, 3 mo = 44%; E group: 1 mo = 17%, 3 mo = 21%, P <0.05). There was good correlation between the CP and MELD scores, which was greater in the emergent groups as compared with the elective group (EM: r = 0.81; E: r = 0.65).

Conclusions

Our study shows that cirrhotic patients who undergo surgery under general anesthesia have an extremely high 1- and 3-month mortality rate that progressively increases with severity of preoperative liver dysfunction. Additionally, the MELD score correlates well with the CTP score, providing a more objective predictor of postoperative mortality in cirrhotic patients undergoing surgery.

Section snippets

Patients and methods

Under an approved institutional review board protocol, a search of the computerized medical records of a tertiary-care VA Medical Center from September of 1999 to September of 2003 was performed. Cirrhotic patients requiring either emergent (EM) or elective (E) surgery under general anesthesia were identified. Age, demographic data, cause of cirrhosis, and type of surgical procedure were collected. The preoperative CTP and MELD (Table 1) scores were calculated and patient short- (30-day) and

Results

Forty patients with documented cirrhosis underwent elective or emergent surgery requiring general anesthesia. The causes of cirrhosis are shown in Table 2. The mean age was 59 ± 2 years (range = 42–81). Twenty-three (58%) patients were Caucasian, 10 (25%) patients were African American, and 7 (17%) patients were Hispanic. Only 2 patients were women. Twenty-four of the surgeries were elective. The remaining 16 were emergent cases. Table 3 lists the surgeries performed. The overall 30-day

Comments

Many medical tools commonly are used beyond their original intended scope, and often they become the standard of care in their new applications. Such was the case with the CTP score, originally devised by purely empiric observation to predict the outcomes of liver patients undergoing portosystemic surgery in the 1960s and subsequently used by surgeons to assess liver patients before any surgery requiring general anesthesia and by United Network for Organ Sharing as one of the factors in

References (17)

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