Nomogram estimates hernia repair riskiness in patients with ascites

Last Updated: 2014-07-25

By Sharon Nirenberg MD

NEW YORK (Reuters Health) - A new nomogram helps estimate 30-day mortality in patients with ascites who are undergoing umbilical hernia repair, researchers reported.

The nomogram takes into account the Model for End-Stage Liver Disease (MELD) score, albumin, WBC count, and platelet count. (A MELD calculator appears here, on the website of the U.S. Department of Health and Human Services: http://1.usa.gov/1uo2071.)

"Patients with chronic liver disease who require surgery represent a significant clinical challenge to surgeons," writes Dr. Fady Saleh and colleagues at the University Health Network in Toronto, Canada, who developed the nomogram. "Furthermore, up to 20% of patients with decompensated liver disease and ascites will develop an umbilical hernia."

To create a tool to help estimate the mortality risk associated with umbilical hernia repair for a patient with ascites and chronic liver disease, the researchers began by selecting patients from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP).

Eligible patients were 18 years or older, diagnosed with ascites due to liver disease or malignancy postoperatively, and underwent umbilical hernia repair between 2005 and 2011.

Of the 688 patients included in the analysis, 300 (44%) were considered emergent cases and 45 (7%) died within 30 days of undergoing umbilical hernia repair.

Multivariate logistic regression with 30-day mortality as the endpoint found that preoperative MELD score, albumin level, white blood cell count, and platelet count were significant predictors of mortality (p<0.05).

The nomogram appears online in the authors' paper, which was published online June 27 in The American Journal of Surgery. Reuters Health reached out to the authors for comment but did not receive a response by deadline.

Dr. Thomas Schiano, a professor of medicine and liver diseases at Mount Sinai Hospital in New York, told Reuters Health. "I think this nomogram is a helpful guide." He added, "I wouldn't follow it 100% because each patient is different, but I think the lab tests are valid and the results make sense."

SOURCE: http://bit.ly/1mNHnHr

Am J Surg 2014.