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

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.