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MELD-Na score associated with postoperative complications in hernia repair in non-cirrhotic patients

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Abstract

Purpose

In patients with cirrhosis, the Model for End-Stage Liver Disease Sodium (MELD-Na) score is a validated predictor of outcomes after transplant and non-transplant surgical procedures. This study investigates the association of MELD-Na score with complications following elective ventral hernia repair in non-cirrhotic patients.

Methods

The ACS NSQIP database was queried (2005–2016) for all elective laparoscopic and open ventral hernia procedures in patients without ascites or esophageal varices. Postoperative outcomes were compared by MELD-Na score using Chi-square tests. Multivariate logistic regression was used to control for potentially confounding variables.

Results

A total of 48,955 elective hernia repairs were identified; 68.7% were open repairs. The overall complication rate (Clavien–Dindo ≥ 1) was 14.3%, with a wound complication rate of 5.5%, and major complication rate (Clavien–Dindo ≥ 3) of 4.3%. A preoperative MELD-Na score ≥ 10 was present in 29.4%. Incremental increases in MELD-Na score (10–14, 15–19, and ≥ 20) were associated with increased overall complications (OR 1.25, CI 1.31–1.37; OR 1.53, CI 1.30–1.80; OR 1.70, CI 1.24–2.31, respectively), major complications (OR 1.42, CI 1.20–1.69; OR 1.85, CI 1.43–2.39; OR 2.13, CI 1.35–3.38, respectively), 30-day mortality (OR 1.58, CI 1.05–2.37; OR 2.34, CI 1.39–3.96; OR 3.16, CI 1.37–7.28, respectively), and return to the operating room (OR 1.19, CI 1.01–1.41; OR 1.38, CI 1.05–1.81; OR 1.78, CI 1.10–2.90, respectively).

Conclusion

MELD-Na score is independently associated with postoperative complications in ventral hernia repair. As an objective and simple predictive model, it may be useful in preoperative risk calculations for complex patients.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Division of GI Surgery, Department of Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC, 28204, USA

    K. A. Schlosser, A. M. Kao, Y. Zhang, T. Prasad, K. R. Kasten, B. R. Davis, B. T. Heniford & P. D. Colavita

Authors
  1. K. A. Schlosser
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  2. A. M. Kao
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  3. Y. Zhang
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  4. T. Prasad
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  5. K. R. Kasten
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  6. B. R. Davis
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  7. B. T. Heniford
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  8. P. D. Colavita
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Contributions

All persons who meet authorship criteria are listed as authors, and all authors certify that they have participated sufficiently in the work to take public responsibility for the content, including participation in the concept, design, analysis, writing, or revision of the manuscript. Conception and design of study: KA Schlosser, MD, BT Heniford, PD Colavita. Acquisition of data: KA Schlosser, T Prasad. Analysis and/or interpretation of data: KA Schlosser, T Prasad. Drafting the manuscript: KA Schlosser, Y Zhang. Revising manuscript: AM Kao MD, T Prasad MD, PD Colavita, BT Heniford KR Kasten, BR Davis.

Corresponding author

Correspondence to P. D. Colavita.

Ethics declarations

Conflict of interest

KS: declares no conflict of interest. AK: declares no conflict of interest. PC: declares conflict of interest not directly related to the submitted work. Industry association with Gore and Allergan. No products or relationships relevant to this research. BD: declares no conflict of interest. KK: declares no conflict of interest. BH: declares conflict of interest not directly related to the submitted work. Industry association with Allergan, Gore, Stryker, Ethicon. No products or relationships relevant to this research. TP: declares no conflict of interest. YZ: declares no conflict of interest.

Ethical approval

This study was IRB exempt due to the deidentified data contained in ACS-NSQIP

Human and animal rights

This article does not contain any studies directly involving human or animal participants, as it is a review of data already collected in a large data registry.

Informed consent

For this type of study, formal consent was not necessary.

Disclosures

The authors have no relevant financial and personal relationships that could inappropriately influence this work or its conclusions. This manuscript has been previously submitted to and withdrawn from the Journal of Surgical Research without previous publication.

Additional information

Accepted for oral presentation at the Academic Surgical Congress, Jacksonville FL, January 2018.

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Schlosser, K.A., Kao, A.M., Zhang, Y. et al. MELD-Na score associated with postoperative complications in hernia repair in non-cirrhotic patients. Hernia 23, 51–59 (2019). https://doi.org/10.1007/s10029-018-1849-2

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  • DOI: https://doi.org/10.1007/s10029-018-1849-2

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