Model for end-stage liver disease score versus Child score in predicting the outcome of surgical procedures in patients with cirrhosis

Table 1 Characteristics of 195 patients with cirrhosis undergoing surgical procedures under general anesthesia

	Total (n =195)	Death or decompensation		P value	Odds ratio
		No (n = 163)	Yes (n = 32)
Mean age (yr)	57.1 ± 11.2	57.2 ± 10.9	56.5 ± 12.5	0.73
Gender, n (%)
Female	79 (40.5)	65 (39.9)	14 (43.8)
Male	116 (59.5)	98 (60.1)	18 (56.3)	0.68
Ethnicity, n (%)
White	159 (81.5)	135 (82.8)	24 (75.0)
African American	27 (13.8)	20 (12.3)	7 (21.9)	0.32
Other	9 (4.6)	8 (4.9)	1 (3.1)
Etiology, n (%)
Hepatitis C	73 (37.4)	61 (37.2)	12 (37.5)	0.99
Cryptogenic	51 (26.2)	43 (26.4)	8 (25.0)	0.87
Alcohol	35 (17.9)	26 (16.0)	9 (28.1)	0.1
Hepatitis B	7 (3.6)	7 (4.3)	0 (0.0)	-
Autoimmune hepatitis	5 (2.6)	5 (3.1)	0 (0.0)	-
Primary sclerosing cholangitis	5 (2.6)	4 (2.5)	1 (3.1)	-
Primary biliary cirrhosis	4 (2.1)	4 (2.5)	0 (0.0)	-
A1 antitrypsin deficiency	3 (1.5)	3 (1.8)	0 (0.0)	-
Non-alcoholic steatohepatitis	2 (1.0)	2 (1.2)	0 (0.0)	-
Amyloidosis	2 (1.0)	2 (1.2)	0 (0.0)	-
Hemochromatosis	1 (0.5)	1 (0.6)	0 (0.0)	-
Cardiac cirrhosis	1 (0.5)	1 (0.6)	0 (0.0)	-
Cystic fibrosis	1 (0.5)	0 (0.0)	1 (3.1)	-
Unknown	5 (2.6)	4 (2.4)	1 (3.1)	-
Mean CTP score ± SD	8.0 ± 1.9	7.8 ± 1.8	9.1 ± 1.9	0.00058
CTP class n (%)
A	41 (21.0)	40 (24.5)	1 (3.1)		1
B	115 (59.0)	95 (58.3)	20 (62.5)	0.0018	8.42
C	39 (20.0)	28 (17.2)	11 (34.4)		15.71
Mean MELD score ± SD	14.2 ± 6.3	13.2 ± 5.2	19.1 ± 5.2	< 0.0001
MELD score (Tertile)
6-11 (T1)		77 (47.2)	6 (18.8)		1
12-15 (T2)		46 (28.2)	10 (31.3)	0.0008	2.79
16-40 (T3)		40 (24.5)	16 (50.0)		5.13
Surgery sites
Gastrointestinal	101 (51.8)	84 (51.5)	17 (53.1)	0.87
Cardiovascular and thoracic	28 (14.4)	22 (13.5)	6 (18.8)	0.42
Genitourinary	24 (12.3)	22 (13.5)	2 (6.3)	0.38
Orthopedic	24 (12.3)	20 (12.3)	4 (12.5)	-
Head and neck	18 (9.2)	15 (9.2)	3 (9.4)	-
Surgery type
Urgent	57 (29.2)	36 (22.1)	21 (65.6)
Elective	138 (70.8)	127 (77.9)	11 (34.4)	< 0.0001

CTP: Child-Turcotte-Pugh; MELD: Model for end-stage liver disease.

Table 2 Surgical procedures performed in 195 patients with cirrhosis

	Total	Elective	Urgent
Procedures	195	138	57
Gastrointestinal	101	66	35
Hernia repair	34	21	13
Cholecystectomy	23	17	6
Exploratory/diagnostic	10	6	4
Biopsy of lesion	9	9	0
Colectomy	6	3	3
Abscess drainage	3	1	2
Hemorrhoid ligation	3	2	1
Pancreatectomy	3	3	0
Small bowel resection	3	0	3
Peptic ulcer oversewing	2	0	2
Appendectomy	1	0	1
Antrectomy (Billroth II)	1	1	0
Gastric bypass	1	1	0
Gastrostomy tube placement	1	1	0
Splenectomy	1	1	0
Cardiovascular and thoracic	28	25	3
Coronary artery bypass	5	5	0
Video-assisted thoracoscopic surgery	5	4	1
Abdominal aortic aneurysm repair	4	4	0
Arteriovenous fistula/graft construction	4	4	0
Cardiac valve replacement/repair	3	3	0
Lung biopsy, open	3	3	0
Pericardiectomy	2	0	2
Heart transplant	1	1	0
Pulmonary lobectomy	1	1	0
Genitourinary	24	21	3
Cystoscopy/ureteroscopy	15	12	3
Dilation and curettage	4	4	0
Hysterectomy	3	3	0
Oophorectomy	1	1	0
Transurethral resection of prostate	1	1	0
Orthopedic	24	12	12
Total hip replacement	6	6	0
Amputation	5	3	2
Infected hip prosthesis removal	4	0	4
Incision and drainage	4	0	4
Open reduction - internal fixation	3	2	1
Arthroscopy	2	1	1
Head and neck	18	14	4
Endoscopic sinus surgery	3	3	0
Laryngoscopy	3	3	0
Parathyroidectomy	3	3	0
Craniotomy	2	1	1
Facial fracture reduction	1	0	1
Mastoidectomy	1	1	0
Neck dissection	1	1	0
Parotidectomy	1	1	0
Scleral buckle	1	1	0
Teeth extraction	1	0	1
Ventriculo-peritoneal shunt	1	0	1

Table 3 Logistic regression analysis: odds ratio of death or decompensation in the postoperative period using the parameters of procedure urgency and the MELD score (A) or the CTP score (B)

	Odds ratio	95% CI	P
A: MELD model
MELD (1 unit increase)	1.1	[1.03-1.17]	0.0044
MELD (5 unit increase)	1.58	[1.16-2.19]
Elective (no vs yes)	4.34	[1.81-10.71]	0.0011
B: CTP model
CTP (1 unit increase)	1.25	[1.00-1.57]	0.0554
Elective (no vs yes)	5.18	[2.20-12.22]	0.0002