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MELD score predicts short-term outcomes after surgical management of proximal humerus fractures: a matched analysis
Brendan Y Shi1, Alexander Upfill-Brown1, Alan Li2
1Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, CA.
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.
Insights
Patients with chronic liver disease (MELD score > 10) undergoing proximal humerus fracture surgery face higher risks of 30-day mortality, readmission, and complications. Open reduction and internal fixation (ORIF) may offer better outcomes than arthroplasty.
Area of Science:
- Orthopedic Surgery
- Hepatology
- Surgical Outcomes Research
Background:
- Chronic liver disease (CLD) impacts surgical risk.
- The Model for End-Stage Liver Disease (MELD) score quantifies liver dysfunction.
- Proximal humerus fractures (PHFs) are common, often requiring surgical intervention.
Purpose of the Study:
- To compare 30-day surgical outcomes for PHFs in patients with and without CLD (MELD score > 10).
- To evaluate the impact of different surgical techniques on outcomes in patients with CLD.
Main Methods:
- Retrospective review of the National Surgical Quality Improvement Program (NSQIP) database.
- Inclusion of patients with PHFs undergoing ORIF, hemiarthroplasty (HA), or shoulder arthroplasty (SA) with calculable MELD scores.
- Propensity score matching to control for confounding variables.
Main Results:
- Patients with MELD score > 10 had significantly higher rates of 30-day mortality, readmission, transfusion, and systemic complications.
- Among patients with MELD score > 10, SA/HA was associated with increased transfusion rates and operative time compared to ORIF.
- No significant differences in mortality, reoperation, readmission, or complications were observed between ORIF, HA, and SA in the overall cohort.
Conclusions:
- Elevated MELD score (> 10) is a significant risk factor for adverse 30-day outcomes after PHF surgery.
- ORIF may be preferable to arthroplasty (SA/HA) in patients with CLD undergoing PHF surgery due to lower transfusion rates and shorter operative times.
