Model for Predicting 90 Day Mortality Following Surgery in Cirrhosis Patient

As shown in Figure 1 (page 1264), the short and long-term mortality is comparable for patients with cirrhosis irregardless of whether no surgery, minor surgery or major surgery is performed. Under the best of circumstances mortality at 5 years is around 50%.

Patient selection: ASA class I to IV. ASA V is associated with a very high mortality rate and surgery is usually not advisable.

Parameters:

(1) age in years

(2) preoperative MELD (Model for End-stage Liver Disease) score

(3) ASA classification

Risk increases for:

(1) age > 70 years: equivalent to an additional 3 points to the MELD score

(2) ASA class IV: equivalent to an additional 5.5 points to the MELD score

adjusted MELD score =

= (preoperative MELD score) + (age adjustment) + (ASA class adjustment)

from Figure 3, page 1267

predicted 90 day mortality =

= (0.02262 * ((MELD)^2)) + (1.932 * (MELD)) + 1.695

Ideal surgical candidate:

(1) < 30 years old

(2) MELD score < 5

(3) ASA class I or II

Additional factors:

(1) Male gender is associated with increased mortality during the first year after surgery.

(2) Emergency surgery does not affect mortality but prolongs hospitalization.