Skip to main content

Advertisement

SpringerLink
Log in

Predication of post-operative outcome of colectomy in ulcerative colitis patients using Model of End-Stage Liver Disease Score

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Model of End-Stage Liver Disease (MELD) score was developed to predict mortality in patients with liver disease. The aim of this study was to investigate the relationship between preoperative MELD score and 30-day surgical outcomes using the American College of Surgeons National Surgical Quality Improvement Program.

Methods

Patients with ulcerative colitis (UC) (ICD: 556.X) who underwent colectomy were identified from NSQIP 2005 to 2013. The primary outcomes were bleeding complications, and overall morbidity and mortality.

Results

A total of 7534 UC patients undergoing colectomy were identified. Patients with a higher MELD score had a longer hospital stay; more bleeding; and cardiac, respiratory, renal, thromboembolic, and septic complications as well as mortality. Patients were stratified into 4 groups by MELD score: < 7, 7–11, 12–15, and > 15 and a stratified multivariate analysis was done. Patients with a MELD score 12–15 (odds ratio [OR] 1.9, 95% confidence interval [CI] 1.1–1.3) and MELD > 15 (OR 2.6, 95%CI 1.5–4.7) were at significant risk for bleeding complication. Apart from the MELD score, the presence of ascites (OR 2.5, 95%CI 1.2–5.1) or varices (OR 1.0, 95%CI 1.01–1.03) was also significantly associated with post-operative bleeding complication. MELD 12–15 and MELD > 15 were also found to be risk factors for overall morbidity (OR 5.3, 95%CI 1.8–15.7; OR 10.3, 95%CI 3.6–29.7, respectively) and mortality (OR 3.3, 95%CI 1.3–8.4; OR 5.9, 95%CI 2.4–14.6, respectively).

Conclusion

UC patients with a higher MELD score were associated with a higher post-colectomy morbidity and mortality. MELD score > 11 was an independent indicator for post-operative bleeding, and overall complications and mortality.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Navaneethan U, Shen B (2010) Hepatopancreatobiliary manifestations and complications associated with inflammatory bowel disease. Inflamm Bowel Dis 16:1598–1619

    Article  Google Scholar 

  2. Gizard E, Ford AC, Bronowicki JP, Peyrin-Biroulet L (2014) Systematic review: the epidemiology of the hepatobiliary manifestations in patients with inflammatory bowel disease. Aliment Pharmacol Ther 40:3–15

    Article  CAS  Google Scholar 

  3. Eade MN (1970) Liver disease in ulcerative colitis. I. Analysis of operative liver biopsy in 138 consecutive patients having colectomy. Ann Intern Med 72:475–487

    Article  CAS  Google Scholar 

  4. Gisbert JP, Luna M, González-Lama Y, Pousa ID, Velasco M, Moreno-Otero R, Maté J (2007) Liver injury in inflammatory bowel disease: long-term follow-up study of 786 patients. Inflamm Bowel Dis 13:1106–1114

    Article  Google Scholar 

  5. Meunier K, Mucci S, Quentin V, Azoulay R, Arnaud JP, Hamy A (2008) Colorectal surgery in cirrhotic patients: assessment of operative morbidity and mortality. Dis Colon Rectum 51:1225–1231

    Article  CAS  Google Scholar 

  6. Neeff H, Mariaskin D, Spangenberg HC, Hopt UT, Makowiec F (2011) Perioperative mortality after non-hepatic general surgery in patients with liver cirrhosis: an analysis of 138 operations in the 2000s using child and MELD scores. J Gastrointest Surg 15:1–11

    Article  Google Scholar 

  7. Zielsdorf SM, Kubasiak JC, Janssen I, Myers JA, Luu MB (2015) A NSQIP analysis of MELD and perioperative outcomes in general surgery. Am Surg 81:755–759

    PubMed  Google Scholar 

  8. Lange EO, Jensen CC, Melton GB, Madoff RD, Kwaan MR (2015) Relationship between model for end-stage liver disease score and 30 day outcomes for patients undergoing elective colorectal resection. Dis Colon Rectum 58:494–501

    Article  Google Scholar 

  9. Hedrick TL, Swenson BR, Friel CM (2013) Model for end-stage liver disease in predicting postoperative mortality of patients undergoing colorectal surgery. Am Surg 79:347–352

    PubMed  Google Scholar 

  10. Lian L, Menon KV, Shen B et al (2012) Inflammatory bowel disease complicated by primary sclerosing cholangitis and cirrhosis: is restorative proctocolectomy safe? Dis Colon Rectum 55:79–84

    Article  Google Scholar 

  11. Malinchoc M, Kamath PS, Gordon FD, Peine CJ, Rank J, ter Borg PCJ (2000) A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology 31:864–871

    Article  CAS  Google Scholar 

  12. Halabi WJ, Jafari MD, Nguyen VQ, Carmichael JC, Mills S, Pigazzi A, Stamos MJ (2013) Blood transfusions in colorectal cancer surgery: incidence, outcomes, and predictive factors: an American College of Surgeons National Surgical Quality Improvement Program analysis. Am J Surg 206:1024–1032

    Article  Google Scholar 

  13. Mathis KL, Benavente-Chenhalls LA, Dozois EJ, Wolff BG, Larson DW (2011) Short- and long-term surgical outcomes in patients undergoing proctocolectomy with ileal pouch-anal anastomosis in the setting of primary sclerosing cholangitis. Dis Colon Rectum 54:787–792

    Article  Google Scholar 

  14. Kartheuser AH, Dozois RR, LaRusso NF et al (1996) Comparison of surgical treatment of ulcerative colitis associated with primary sclerosing cholangitis: ileal pouch-anal anastomosis versus Brooke ileostomy. Mayo Clin Proc 71:748–756

    Article  CAS  Google Scholar 

  15. Mathis KL, Dozois EJ, Larson DW, Cima RR, Sarmiento JM, Wolff BG, Heimbach JK, Pemberton JH (2008) Ileal pouch–anal anastomosis and liver transplantation for ulcerative colitis complicated by primary sclerosing cholangitis. Br J Surg 95:882–886

    Article  CAS  Google Scholar 

  16. Gorgun E, Remzi FH, Manilich E, Preen M, Shen B, Fazio VW (2005) Surgical outcome in patients with primary sclerosing cholangitis undergoing ileal pouch-anal anastomosis: a case-control study. Surgery 138:631–637

    Article  Google Scholar 

  17. Cullen S, Chapman R (2003) Primary sclerosing cholangitis. Autoimmun Rev 2:305–312

    Article  CAS  Google Scholar 

  18. Gustot T, Durand F, Lebrec D, Vincent JL, Moreau R (2009) Severe sepsis in cirrhosis. Hepatology 50:2022–2033

    Article  CAS  Google Scholar 

  19. Poritz LS, Koltun WA (2003) Surgical management of ulcerative colitis in the presence of primary sclerosing cholangitis. Dis Colon Rectum 46:173–178

    Article  Google Scholar 

Download references

Funding

This study was financially supported by the National Key Clinical Discipline (China).

Dr. Bo Shen is supported by the Ed and Joey Story Endowed Chair.

Author information

Authors and Affiliations

  1. Department of Colorectal Surgery and Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, the Sixth Affiliated Hospital, Sun Yat-Sen University, 26 Yuancun Erheng Rd, Guangzhou, 510642, Guangdong, China

    Nan Lan & Jianping Wang

  2. Department of Gastroenterology, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, 44195, USA

    Nan Lan & Bo Shen

Authors
  1. Nan Lan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bo Shen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jianping Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jianping Wang.

Ethics declarations

Disclosure

The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) and the hospitals participating in the program are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lan, N., Shen, B. & Wang, J. Predication of post-operative outcome of colectomy in ulcerative colitis patients using Model of End-Stage Liver Disease Score. Int J Colorectal Dis 33, 1763–1772 (2018). https://doi.org/10.1007/s00384-018-3147-y

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-018-3147-y

Keywords

Search

Navigation