MELD-Na Score as a Predictor of Postoperative Complications in Ventral Skull Base Surgery.

Abstract

Objective  The Model for End-stage Liver Disease-Sodium (MELD-Na) score was designed for prognosis of chronic liver disease and has been predictive of outcomes in a variety of procedures. Few studies have investigated its utility in otolaryngology. This study uses the MELD-Na score to investigate the association between liver health and ventral skull base surgical complications. Methods  The National Surgical Quality Improvement Program database was used to identify patients who underwent ventral skull base procedures between 2005 and 2015. Univariate and multivariate analyses were performed to investigate the association between elevated MELD-Na score and postoperative complications. Results  We identified 1,077 patients undergoing ventral skull base surgery with laboratory values required to calculate the MELD-Na score. The mean age was 54.2 years. The mean MELD-Na score was 7.70 (standard deviation = 2.04). Univariate analysis showed that elevated MELD-Na score was significantly associated with increased age (58.6 vs 53.8 years) and male gender (70.8 vs 46.1%). Elevated MELD-Na score was associated with increased rates of postoperative acute renal failure, transfusion, septic shock, surgical complications, and extended length of hospital stay. On multivariate analysis, associations between elevated MELD-Na and increased risk of perioperative transfusions (odds ratio [OR], 1.62; 95% confidence interval [CI], 1.20-2.93; p  = 0.007) and surgical complications (OR, 1.58; 95% CI, 1.25-2.35; p  = 0.009) remained significant. Conclusions  This analysis points to an association between liver health and postoperative complications in ventral skull base surgery. Future research investigating this association is warranted.