Does the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) accurately predict mortality for patients with elevated MELD scores?

Background: The Model for End Stage Liver Disease (MELD) predicts mortality for liver disease patients. The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) estimates mortality risk for surgical patients; however, NSQIP does not collect data regarding liver disease. This study's aim was to examine the accuracy of NSQIP mortality estimates for patients with elevated MELD scores.

Methods: NSQIP participant user files from 2005 to 2016 were queried. MELD scores were calculated and patients with scores ≥10 included. NSQIP-predicted mortality was compared to actual mortality.

Results: 268,873 patients met inclusion criteria. Predicted and observed number of 30-day postoperative deaths were 20,644 (7.7%) and 21,764 (8.1%). For patients with MELD ≥24, NSQIP-predicted 30-day mortality underestimated actual mortality. For patients with MELD ≤22, predicted and actual risks were similar.

Conclusion: NSQIP predicts 30-day mortality risk well for patients with MELD scores from 10 to 22, but underestimates risk for patients with higher MELD scores.