Shi Brendan Y, Upfill-Brown Alexander, Li Alan, Wu Shannon Y, Ahlquist Seth, Hart Christopher M, Kremen Thomas J, Lee Christopher, Stavrakis Alexandra I
Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, CA.
David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA.
OTA Int. 2023 Oct 27;6(4):e289. doi: 10.1097/OI9.0000000000000289. eCollection 2023 Dec.
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.
This was a retrospective database review.
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.
Open reduction and internal fixation, hemiarthroplasty, or shoulder arthroplasty was used for treatment.
Thirty-day complications, mortality, readmission, and reoperation rates were measured.
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.
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.
Prognostic Level III.
我们旨在评估根据终末期肝病模型（MELD）评分大于10定义的有或无慢性肝病的患者在肱骨近端骨折（PHF）手术治疗后30天结局的差异。
这是一项回顾性数据库审查。
纳入所有参与美国外科医师学会国家外科质量改进计划数据库的中心。
患者/参与者：纳入符合以下条件的肱骨近端骨折患者：（1）接受切开复位内固定术（ORIF）、半关节成形术（HA）或全肩关节置换术（SA），且（2）有可计算的MELD评分。
采用切开复位内固定、半关节成形术或全肩关节置换术进行治疗。
测量30天并发症、死亡率、再入院率和再次手术率。
在确定的1732例PHF患者中，300例MELD评分高于10。在按显著协变量进行倾向匹配后，发现MELD评分高于10与30天死亡率、30天再入院率、72小时内输血率和全身并发症发生率较高显著相关。在MELD评分高于10的患者中，采用SA或HA而非ORIF治疗与输血率较高和手术时间较长相关。各治疗组在死亡率、再次手术、再入院或并发症方面无显著差异。
MELD评分高于10与肱骨近端骨折手术患者发生手术并发症、输血和死亡的风险较高相关。在MELD评分高于10的患者中，与关节成形术或半关节成形术相比，ORIF与较低的输血率和较短的手术时间相关。
预后III级。
