Colorectal Anastomosis Versus Colostomy Creation in High MELD Patients: An ACS-NSQIP Analysis.

This article examines the impact of surgical choice—colorectal anastomosis versus colostomy formation—on outcomes in patients with high Model for End-Stage Liver Disease (MELD) scores undergoing nonelective colorectal surgery, using data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). The study found that while higher MELD scores correlate with increased mortality, patients with high MELD scores (>19) who received a colostomy had significantly lower in-hospital mortality (28.4% vs. 41.1%) and fewer returns to the operating room compared to those undergoing primary anastomosis, despite a higher rate of wound complications. Multivariate analysis identified colostomy formation as an independent predictor of improved survival in this high-risk group. These findings suggest that colostomy may be a preferable surgical option over anastomosis for patients with severe liver dysfunction in urgent colorectal surgery, although further prospective research is needed to confirm causality and optimize decision-making.