MELD score is predictive of postoperative morbidity and mortality in patients with acute appendicitis undergoing appendectomy: ACS-NSQIP data analysis

Fady Daniel; Mariam Baydoun; Ali R Chaitou; Rudy Mrad; Maha Makki; Mohamad Khalife; Hani Tamim

doi:10.1007/s00464-025-12308-w

MELD score is predictive of postoperative morbidity and mortality in patients with acute appendicitis undergoing appendectomy: ACS-NSQIP data analysis

Surg Endosc. 2026 Feb;40(2):955-964. doi: 10.1007/s00464-025-12308-w. Epub 2025 Oct 31.

Authors

Fady Daniel¹, Mariam Baydoun², Ali R Chaitou², Rudy Mrad², Maha Makki³, Mohamad Khalife⁴, Hani Tamim^{3

5}

Affiliations

¹ Division of Gastroenterology and Hepatology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon. fd21@aub.edu.lb.
² Division of Gastroenterology and Hepatology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
³ Department of Internal Medicine, Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon.
⁴ Division of General Surgery, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
⁵ College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.

PMID: 41171421
DOI: 10.1007/s00464-025-12308-w

Abstract

Background: The model for end-stage liver disease (MELD) score has been shown to be a valid predictive tool for postoperative risks across various types of surgeries, after initially being restricted to liver transplantation eligibility assessment in cirrhotic patients. Since appendectomy is one of the most common surgical procedures, our objective is to compare the impact of the three versions of the MELD score (1.0, 2.0, and 3.0) on the risk assessment of 30-day postoperative morbidity and mortality in patients undergoing appendectomy for acute appendicitis.

Methods: Data on patients undergoing appendectomy for acute appendicitis were collected from the ACS-NSQIP database from 2018 to 2022 using the Current Procedural Terminology (CPT) codes 44,950, 44,960, and 44,970. The different MELD scores and outcomes were compared using the Chi-square test. The outcomes measured included 30-day mortality, wound infection, cardiac, respiratory, urinary, and central nervous system complications, thromboembolism, sepsis, bleeding, return to the operating room, and composite morbidity.

Results: A total of 121,207 patients were included, with a mean age of 45.31 ± 17.89 years, of which 58,495 (48.3%) were females. The majority, 102,895 (90.7%) patients, underwent laparoscopic appendectomy, whereas 10,599 (9.3%) had open appendectomy. The overall 30-day surgical mortality was 0.5% (567/121,207), and postoperative sepsis was observed in 5.8% (7,063/121,207). All the MELD score versions significantly predicted the outcomes independently of the surgical approach (laparoscopic/open appendectomy, simple/complicated appendicitis) with means of 8.21 ± 2.81, 9.01 ± 3.39, and 9.21 ± 3.26 for MELD 1.0, MELD 2.0, and MELD 3.0 scores, respectively. MELD 3.0 score noticeably outperformed its predecessors regarding all the outcomes. Patients with a score ≥ 11 had a higher prevalence of postoperative complications.

Conclusion: The MELD score, in its three versions, is a valid tool for assessing 30-day morbidity and mortality risk following appendectomy for acute appendicitis. MELD 3.0, with a cutoff of 11, demonstrated superior predictive performance.

Keywords: Appendectomy; Appendicitis; MELD score; Mortality; NSQIP; Sepsis.

MeSH terms

Acute Disease
Adult
Appendectomy* / adverse effects
Appendectomy* / methods
Appendectomy* / mortality
Appendicitis* / complications
Appendicitis* / mortality
Appendicitis* / surgery
End Stage Liver Disease* / complications
End Stage Liver Disease* / diagnosis
Female
Humans
Male
Middle Aged
Postoperative Complications* / epidemiology
Postoperative Complications* / etiology
Postoperative Complications* / mortality
Retrospective Studies
Risk Assessment / methods
Severity of Illness Index