Predictive value of preoperative MELD-Na score versus APRI for postoperative outcomes after infrainguinal bypass in peripheral artery disease

Peripheral artery disease is a prevalent and debilitating condition, with infrainguinal occlusive disease often leading to critical limb-threatening ischemia. Although surgical revascularization via infrainguinal bypass remains a cornerstone of treatment, postoperative complications and graft failure pose substantial risks, particularly in patients with comorbid conditions. Chronic liver disease, even in subclinical forms, may adversely affect surgical outcomes. This study investigates the prognostic utility of the Model for End-Stage Liver Disease-Sodium (MELD-Na) and Aspartate Aminotransferase to Platelet Ratio Index (APRI) scores in predicting postoperative complications and mortality in peripheral artery disease patients undergoing infrainguinal bypass surgery. A retrospective review was conducted on 98 peripheral artery disease patients who underwent elective infrainguinal bypass surgery between December 2018 and December 2022. Preoperative MELD-Na and APRI scores were calculated based on laboratory values. Patients were followed for two years postoperatively, and data on graft patency, reintervention, complications, and mortality were analyzed. Higher MELD-Na scores (> 15) were significantly associated with increased rates of bypass occlusion (52.6%), reintervention (57.9%), pulmonary complications (31.6%), and mortality (47.4%) (p <.05). Logistic regression analysis confirmed MELD-Na > 15 as a strong independent predictor of adverse outcomes. In contrast, APRI scores showed no significant association with prognosis or mortality. The MELD-Na score may serve as a valuable tool for predicting surgical outcomes in PAD patients undergoing infrainguinal bypass, even in the absence of known liver disease. Incorporating MELD-Na into preoperative risk assessment could aid in identifying high-risk individuals and optimizing treatment strategies. APRI, however, lacks similar predictive value in this patient population.