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Abstract：
UNASSIGNED: The aim of this study was to assess the efficacy of the Model for End-Stage Liver Disease (MELD) score in predicting postoperative complications following total shoulder arthroplasty (TSA).
UNASSIGNED: The American College of Surgeons National Surgical Quality Improvement database was queried for all patients who underwent TSA between 2015 and 2019. The study population was subsequently classified into two categories: those with a MELD score ≥ 10 and those with a MELD score < 10. A total of 5265 patients undergoing TSA between 2015 and 2019 were included in this study. Among these, 4690 (89.1%) patients had a MELD score ≥ 10, while 575 (10.9%) patients had a MELD score < 10. Postoperative complications within 30 days of the TSA were collected. Multivariate logistic regression analysis was conducted to explore the correlation between a MELD score ≥ 10 and postoperative complications. The anchor based optimal cutoff was calculated by receiver operating characteristic analysis to determine the MELD score cutoff that most accurately predicts a specific complication. Youden\'s index (J) determined the optimal cutoff point calculation for the maximum sensitivity and specificity; these were deemed to be \"acceptable\" if the area under curve (AUC) was greater than 0.7 and \"excellent\" if greater than 0.8.
UNASSIGNED: Multivariate regression analysis found a MELD score ≥ 10 to be independently associated with higher rates of reoperation (OR, 2.08; P = .013), cardiac complications (OR, 3.37; P = .030), renal complications (OR, 7.72; P = .020), bleeding transfusions (OR, 3.23; P < .001), and nonhome discharge (OR, 1.75; P < .001). The receiver operating characteristic analysis showed that AUC for a MELD score cutoff of 7.61 as a predictor of renal complications was 0.87 (excellent) with sensitivity of 100.0% and specificity of 70.0%. AUC for a MELD score cutoff of 7.76 as a predictor of mortality was 0.76 (acceptable) with sensitivity of 81.8% and specificity of 71.0%.
UNASSIGNED: A MELD score ≥ 10 was correlated with high rates of reoperation, cardiac complications, renal complications, bleeding transfusions, and nonhome discharge following TSA. MELD score cutoffs of 7.61 and 7.76 were effective in predicting renal complications and mortality, respectively.
UNASSIGNED: The American College of Surgeons National Surgical Quality Improvement database was queried for all patients who underwent TSA between 2015 and 2019. The study population was subsequently classified into two categories: those with a MELD score ≥ 10 and those with a MELD score < 10. A total of 5265 patients undergoing TSA between 2015 and 2019 were included in this study. Among these, 4690 (89.1%) patients had a MELD score ≥ 10, while 575 (10.9%) patients had a MELD score < 10. Postoperative complications within 30 days of the TSA were collected. Multivariate logistic regression analysis was conducted to explore the correlation between a MELD score ≥ 10 and postoperative complications. The anchor based optimal cutoff was calculated by receiver operating characteristic analysis to determine the MELD score cutoff that most accurately predicts a specific complication. Youden\'s index (J) determined the optimal cutoff point calculation for the maximum sensitivity and specificity; these were deemed to be \"acceptable\" if the area under curve (AUC) was greater than 0.7 and \"excellent\" if greater than 0.8.
UNASSIGNED: Multivariate regression analysis found a MELD score ≥ 10 to be independently associated with higher rates of reoperation (OR, 2.08; P = .013), cardiac complications (OR, 3.37; P = .030), renal complications (OR, 7.72; P = .020), bleeding transfusions (OR, 3.23; P < .001), and nonhome discharge (OR, 1.75; P < .001). The receiver operating characteristic analysis showed that AUC for a MELD score cutoff of 7.61 as a predictor of renal complications was 0.87 (excellent) with sensitivity of 100.0% and specificity of 70.0%. AUC for a MELD score cutoff of 7.76 as a predictor of mortality was 0.76 (acceptable) with sensitivity of 81.8% and specificity of 71.0%.
UNASSIGNED: A MELD score ≥ 10 was correlated with high rates of reoperation, cardiac complications, renal complications, bleeding transfusions, and nonhome discharge following TSA. MELD score cutoffs of 7.61 and 7.76 were effective in predicting renal complications and mortality, respectively.
摘要：
本研究的目的是评估终末期肝病模型（MELD）评分在预测全肩关节置换术（TSA）后术后并发症中的功效。
■美国外科医生学会国家外科质量改善数据库查询了2015年至2019年期间接受TSA治疗的所有患者。随后将研究人群分为两类：MELD评分≥10的人群和MELD评分<10的人群。在2015年至2019年期间，共有5265名接受TSA的患者被纳入本研究。其中,4690例（89.1%）患者的MELD评分≥10，575例（10.9%）患者的MELD评分<10。收集TSA术后30天内的并发症。采用多因素logistic回归分析MELD评分≥10分与术后并发症的相关性。通过接收器操作特性分析计算基于锚的最佳截止值，以确定最准确预测特定并发症的MELD分数截止值。Youden指数（J）确定了最大灵敏度和特异性的最佳截止点计算；如果曲线下面积（AUC）大于0.7，则认为它们是“可接受的”，如果大于0.8，则认为它们是“极好的”。
■多元回归分析发现，MELD评分≥10与较高的再手术率独立相关（OR，2.08；P=.013），心脏并发症（或，3.37；P=.030)，肾脏并发症（OR，7.72；P=.020），出血输血（或，3.23;P<.001),和非家庭出院(或，1.75;P<.001)。受试者工作特征分析显示，作为肾脏并发症预测因子的MELD评分截止值7.61的AUC为0.87（优秀），灵敏度为100.0％，特异性为70.0％。作为死亡率预测因子的MELD评分截止值7.76的AUC为0.76（可接受），敏感性为81.8%，特异性为71.0%。
■MELD评分≥10与高再手术率相关，心脏并发症,肾脏并发症，输血出血,以及运输安全管理局后的非家庭出院。MELD评分截止值7.61和7.76可有效预测肾脏并发症和死亡率。分别。
■美国外科医生学会国家外科质量改善数据库查询了2015年至2019年期间接受TSA治疗的所有患者。随后将研究人群分为两类：MELD评分≥10的人群和MELD评分<10的人群。在2015年至2019年期间，共有5265名接受TSA的患者被纳入本研究。其中,4690例（89.1%）患者的MELD评分≥10，575例（10.9%）患者的MELD评分<10。收集TSA术后30天内的并发症。采用多因素logistic回归分析MELD评分≥10分与术后并发症的相关性。通过接收器操作特性分析计算基于锚的最佳截止值，以确定最准确预测特定并发症的MELD分数截止值。Youden指数（J）确定了最大灵敏度和特异性的最佳截止点计算；如果曲线下面积（AUC）大于0.7，则认为它们是“可接受的”，如果大于0.8，则认为它们是“极好的”。
■多元回归分析发现，MELD评分≥10与较高的再手术率独立相关（OR，2.08；P=.013），心脏并发症（或，3.37；P=.030)，肾脏并发症（OR，7.72；P=.020），出血输血（或，3.23;P<.001),和非家庭出院(或，1.75;P<.001)。受试者工作特征分析显示，作为肾脏并发症预测因子的MELD评分截止值7.61的AUC为0.87（优秀），灵敏度为100.0％，特异性为70.0％。作为死亡率预测因子的MELD评分截止值7.76的AUC为0.76（可接受），敏感性为81.8%，特异性为71.0%。
■MELD评分≥10与高再手术率相关，心脏并发症,肾脏并发症，输血出血,以及运输安全管理局后的非家庭出院。MELD评分截止值7.61和7.76可有效预测肾脏并发症和死亡率。分别。
