Ascites: A marker for increased surgical risk unaccounted for by the model for end-stage liver disease (MELD) score for general surgical procedures.

BACKGROUND: Ascites and the Model for End-Stage Liver Disease score have both been shown to independently correlate with surgical morbidity and mortality. We evaluated if incorporating the presence of ascites changed postoperative risk as assessed by the Model for End-Stage Liver Disease score.

METHODS: Data originated from the National Surgical Quality Improvement Program database from 2005-2014. Patients undergoing hernia repair, adhesiolysis, and cholecystectomy were included. Univariate analysis and logistic regression stratified by Model for End-Stage Liver Disease score and presence of ascites was performed.

RESULTS: A total of 30,391 patients were analyzed. When compared to low Model for End-Stage Liver Disease stratum without ascites, the presence of ascites predicted increased risk for complications (low Model for End-Stage Liver Disease with ascites odds ratio 3.22, 95% confidence interval [2.00-5.18], moderate Model for End-Stage Liver Disease with ascites odds ratio 3.70, 95% confidence interval [2.64-5.19], high Model for End-Stage Liver Disease with ascites odds ratio 6.38, 95% confidence interval [4.39-9.26]). These findings hold true for mortality as well (low Model for End-Stage Liver Disease with ascites odds ratio 9.40 95% confidence interval [3.53-25.01], moderate Model for End-Stage Liver Disease with ascites odds ratio 15.24 95% confidence interval [8.17-28.45], high Model for End-Stage Liver Disease with ascites odds ratio 28.56 95% confidence interval [15.43-52.88]).

CONCLUSIONS: Ascites increased the risk of morbidity and mortality across multiple general surgery operations. Model for End-Stage Liver Disease may underestimate surgical risk in patients with ascites. Predictive models inclusive of ascites may more accurately predict the perioperative risk of these complex patients.