Reuters Health Information: Nomogram estimates hernia repair riskiness in patients with ascites
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."
Am J Surg 2014.