![]() ![]() Liver texture was categorized as normal, congested/fatty, and cirrhotic. Patients with reported liver texture variable as reported in the hepatectomy targeted dataset were included in this study. The University of Virginia Institutional Review Board has designated the ACS NSQIP PUF and targeted datasets as a publically available de-identified data exempt from formal IRB review. Patient data abstracted from the ACS NSQIP PUF were merged with data from the targeted dataset for use in this retrospective cohort study. An additional hepatectomy-specific targeted module was released in 2014 and available subsequently. ACS NSQIP is a deidentified, independently collected, Health Insurance Portability and Accountability Act (HIPAA) compliant dataset that includes patient-level data from a nationwide cohort of participating hospitals. Patient selection and variable definitionsĪll patients ≥18 years who had a liver resection between 20 were abstracted from The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Participant Use File (PUF). Given published equipoise surrounding utility of the MELD score among patients with varying degrees of underlying liver disease, we aimed to estimate independent effects of MELD score and chronic liver disease on postoperative morbidity and mortality. It relies on objective, readily available data, which can be directly compared between patient populations. MELD score remains an attractive preoperative tool for assessment of postoperative outcomes after liver surgery. Interestingly, contemporaneous studies demonstrated lack of association between MELD score and mortality after liver resection among patients without cirrhosis ( 9, 10). Subsequent studies established utility of MELD in predicting mortality among patients with cirrhosis selected for resection ( 5, 8). MELD score was initially developed as an alternative Child-Pugh-Turcotte score to predict mortality of patients with cirrhosis who had transjugular intrahepatic portosystemic shunts and a separate cohort of patients with chronic liver disease awaiting liver transplantation ( 6, 7). Stratification of risk among patients with cirrhosis has been particularly challenging and a number of studies have provided evidence linking greater liver disease scores, such as Model for End-Stage Liver Disease (MELD) score, with worse patient-specific outcomes ( 5). Presence of underlying chronic liver disease such as steatosis, fibrosis, or cirrhosis has also been associated with postoperative outcomes ( 4). A number of factors such as extent of resection and planned future liver remnant have been associated with postoperative morbidity and mortality ( 1– 3). Patient selection criteria continues to be important in liver surgery. ![]()
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