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

Liam S. Flanagan; Chris B. Choi; Vraj P. Shah; Aakash D. Shah; Aksha Parray; Jordon G. Grube; Christina H. Fang; Soly Baredes; Jean Anderson Eloy

doi:10.1055/a-1842-8668

Journal of Neurological Surgery Part B: Skull Base, Table of Contents

J Neurol Surg B Skull Base 2023; 84(04): 405-412
DOI: 10.1055/a-1842-8668

Original Article

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

Liam S. Flanagan

¹Department of Otolaryngology – Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, United States

,

Chris B. Choi

¹Department of Otolaryngology – Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, United States

,

Vraj P. Shah

¹Department of Otolaryngology – Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, United States

,

Aakash D. Shah

¹Department of Otolaryngology – Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, United States

,

Aksha Parray

¹Department of Otolaryngology – Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, United States

,

Jordon G. Grube

¹Department of Otolaryngology – Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, United States

,

Christina H. Fang

¹Department of Otolaryngology – Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, United States

,

Soly Baredes

¹Department of Otolaryngology – Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, United States

²Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, United States

,

Jean Anderson Eloy

¹Department of Otolaryngology – Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, United States

²Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, United States

³Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, United States

⁴Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, United States

⁵Department of Otolaryngology and Facial Plastic Surgery, Saint Barnabas Medical Center - RWJBarnabas Health, Livingston, New Jersey, United States

› Author Affiliations

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.

Keywords

ventral skull base - MELD-Na - head and neck surgery - complications

Full Text

References

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