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Background <p>The model for end-stage liver disease (MELD) score has been shown to be a valid predictive tool for postoperative risks across various types of surgeries, after initially being restricted to liver transplantation eligibility assessment in cirrhotic patients. Since appendectomy is one of the most common surgical procedures, our objective is to compare the impact of the three versions of the MELD score (1.0, 2.0, and 3.0) on the risk assessment of 30-day postoperative morbidity and mortality in patients undergoing appendectomy for acute appendicitis.</p> Methods <p>Data on patients undergoing appendectomy for acute appendicitis were collected from the ACS-NSQIP database from 2018 to 2022 using the Current Procedural Terminology (CPT) codes 44,950, 44,960, and 44,970. The different MELD scores and outcomes were compared using the Chi-square test. The outcomes measured included 30-day mortality, wound infection, cardiac, respiratory, urinary, and central nervous system complications, thromboembolism, sepsis, bleeding, return to the operating room, and composite morbidity.</p> Results <p>A total of 121,207 patients were included, with a mean age of 45.31 ± 17.89&#xa0;years, of which 58,495 (48.3%) were females. The majority, 102,895 (90.7%) patients, underwent laparoscopic appendectomy, whereas 10,599 (9.3%) had open appendectomy. The overall 30-day surgical mortality was 0.5% (567/121,207), and postoperative sepsis was observed in 5.8% (7,063/121,207). All the MELD score versions significantly predicted the outcomes independently of the surgical approach (laparoscopic/open appendectomy, simple/complicated appendicitis) with means of 8.21 ± 2.81, 9.01 ± 3.39, and 9.21 ± 3.26 for MELD 1.0, MELD 2.0, and MELD 3.0 scores, respectively. MELD 3.0 score noticeably outperformed its predecessors regarding all the outcomes. Patients with a score ≥ 11 had a higher prevalence of postoperative complications.</p> Conclusion <p>The MELD score, in its three versions, is a valid tool for assessing 30-day morbidity and mortality risk following appendectomy for acute appendicitis. MELD 3.0, with a cutoff of 11, demonstrated superior predictive performance.</p>

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MELD score is predictive of postoperative morbidity and mortality in patients with acute appendicitis undergoing appendectomy: ACS-NSQIP data analysis

  • 期刊论文

  • 发表日期：

    2025年10月31日

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  • Fady Daniel,
  • Mariam Baydoun,
  • Ali R. Chaitou,
  • Rudy Mrad,
  • Maha Makki,
  • Mohamad Khalife,
  • Hani Tamim

摘要

Background

The model for end-stage liver disease (MELD) score has been shown to be a valid predictive tool for postoperative risks across various types of surgeries, after initially being restricted to liver transplantation eligibility assessment in cirrhotic patients. Since appendectomy is one of the most common surgical procedures, our objective is to compare the impact of the three versions of the MELD score (1.0, 2.0, and 3.0) on the risk assessment of 30-day postoperative morbidity and mortality in patients undergoing appendectomy for acute appendicitis.

Methods

Data on patients undergoing appendectomy for acute appendicitis were collected from the ACS-NSQIP database from 2018 to 2022 using the Current Procedural Terminology (CPT) codes 44,950, 44,960, and 44,970. The different MELD scores and outcomes were compared using the Chi-square test. The outcomes measured included 30-day mortality, wound infection, cardiac, respiratory, urinary, and central nervous system complications, thromboembolism, sepsis, bleeding, return to the operating room, and composite morbidity.

Results

A total of 121,207 patients were included, with a mean age of 45.31 ± 17.89 years, of which 58,495 (48.3%) were females. The majority, 102,895 (90.7%) patients, underwent laparoscopic appendectomy, whereas 10,599 (9.3%) had open appendectomy. The overall 30-day surgical mortality was 0.5% (567/121,207), and postoperative sepsis was observed in 5.8% (7,063/121,207). All the MELD score versions significantly predicted the outcomes independently of the surgical approach (laparoscopic/open appendectomy, simple/complicated appendicitis) with means of 8.21 ± 2.81, 9.01 ± 3.39, and 9.21 ± 3.26 for MELD 1.0, MELD 2.0, and MELD 3.0 scores, respectively. MELD 3.0 score noticeably outperformed its predecessors regarding all the outcomes. Patients with a score ≥ 11 had a higher prevalence of postoperative complications.

Conclusion

The MELD score, in its three versions, is a valid tool for assessing 30-day morbidity and mortality risk following appendectomy for acute appendicitis. MELD 3.0, with a cutoff of 11, demonstrated superior predictive performance.