MELD score predicts short-term outcomes after surgical management of proximal humerus fractures: a matched analysis

Brendan Y. Shi, MD; Alexander Upfill-Brown, MD MSc; Alan Li, BS; Shannon Y. Wu, BS; Seth Ahlquist, MD; Christopher M. Hart, MD; Thomas J. Kremen, MD; Christopher Lee, MD; Alexandra I. Stavrakis, MD

doi:10.1097/OI9.0000000000000289

OTA International (Dec 2023)

MELD score predicts short-term outcomes after surgical management of proximal humerus fractures: a matched analysis

Brendan Y. Shi, MD,
Alexander Upfill-Brown, MD MSc,
Alan Li, BS,
Shannon Y. Wu, BS,
Seth Ahlquist, MD,
Christopher M. Hart, MD,
Thomas J. Kremen, MD,
Christopher Lee, MD,
Alexandra I. Stavrakis, MD

Affiliations

Brendan Y. Shi, MD: a Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, CA
Alexander Upfill-Brown, MD MSc: a Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, CA
Alan Li, BS: b David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
Shannon Y. Wu, BS: b David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
Seth Ahlquist, MD: a Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, CA
Christopher M. Hart, MD: a Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, CA
Thomas J. Kremen, MD: a Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, CA
Christopher Lee, MD: a Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, CA
Alexandra I. Stavrakis, MD: a Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, CA

DOI: https://doi.org/10.1097/OI9.0000000000000289
Journal volume & issue: Vol. 6, no. 4

Abstract

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Abstract. Objective:. We aimed to evaluate the difference in 30-day outcomes after surgical management of proximal humerus fractures (PHFs) between patients with and without chronic liver disease as defined by a MELD score greater than 10. Design:. This was a retrospective database review. Setting:. All centers participating in the American College of Surgeons National Surgical Quality Improvement Program database were included. Patients/Participants:. Patients with proximal humerus fractures who (1) underwent ORIF, HA, or SA and (2) had calculable MELD scores were included. Intervention:. Open reduction and internal fixation, hemiarthroplasty, or shoulder arthroplasty was used for treatment. Main outcome measurements:. Thirty-day complications, mortality, readmission, and reoperation rates were measured. Results:. Of the total 1732 PHF patients identified, 300 had a MELD score higher than 10. After propensity matching by significant covariates, MELD score higher than 10 was found to be significantly associated with higher rates of 30-day mortality, 30-day readmission, transfusion within 72 hours, and systemic complications. Among patients with a MELD score higher than 10, treatment with SA or HA instead of ORIF was associated with a higher rate of transfusion and longer operative time. There were no significant differences between treatment cohorts regarding mortality, reoperation, readmission, or complications. Conclusions:. A MELD score higher than 10 is associated with higher risk of surgical complications, transfusion, and death in patients undergoing surgery for proximal humerus fractures. Among patients with a MELD score higher than 10, ORIF was associated with a lower transfusion rate and shorter operative time than arthroplasty or hemiarthroplasty. Level of Evidence:. Prognostic Level III.

Published in OTA International

ISSN: 2574-2167 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Surgery: Orthopedic surgery
Website: https://journals.lww.com/otainternational/pages/default.aspx

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