Valentin Neuhaus1, Arjan G J Bot1, Christiaan H J Swellengrebel1, Nitin B Jain2, Jon J P Warner3, David C Ring4. 1. Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA, USA. 2. Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Harvard Medical School, Boston, MA, USA; Harvard Shoulder Service, Massachusetts General Hospital, Boston, MA, USA; Department of Orthopedics, Brigham and Women's Hospital, Boston, MA, USA. 3. Harvard Shoulder Service, Massachusetts General Hospital, Boston, MA, USA. 4. Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA, USA. Electronic address: dring@partners.org.
Abstract
BACKGROUND: This study tests the null hypothesis that, among patients aged 65 and older admitted to a United States hospital with an isolated fracture of the proximal humerus (no other injuries or fractures), there are no differences between operative (fixation or arthroplasty) and nonoperative treatments with respect to inpatient adverse events, inpatient mortality, and discharge to a long-term care facility rates accounting for comorbidities. METHODS: Using a large national database representing an estimated 132,005 patients aged 65 and older admitted to a US hospital with an isolated proximal humerus fracture between 2003 and 2007. Sixty-one percent did not have surgery, 22% were treated with open reduction and internal fixation (ORIF), and 17% were treated with arthroplasty. RESULTS: The risk of an in hospital adverse event was 21% overall and was 4.4 times greater with arthroplasty and 2.7 times greater with ORIF compared to nonoperative treatment. The risk of in hospital death was 1.8% overall and was 2.8 times greater with ORIF compared to nonoperative treatment. Patients treated operatively were less likely to be discharged to a long-term facility compared to patients treated nonoperatively. CONCLUSION: In spite of a tendency to treat the most infirm patients (those that are not discharged to home) nonoperatively, operative treatment (open reduction and internal fixation in particular) is an independent risk factor for inpatient adverse events and mortality in older-aged patients admitted to the hospital with an isolated fracture of the proximal humerus and should perhaps be offered more judiciously. LEVEL OF EVIDENCE: Level III, retrospective cohort study, treatment study.
BACKGROUND: This study tests the null hypothesis that, among patients aged 65 and older admitted to a United States hospital with an isolated fracture of the proximal humerus (no other injuries or fractures), there are no differences between operative (fixation or arthroplasty) and nonoperative treatments with respect to inpatient adverse events, inpatient mortality, and discharge to a long-term care facility rates accounting for comorbidities. METHODS: Using a large national database representing an estimated 132,005 patients aged 65 and older admitted to a US hospital with an isolated proximal humerus fracture between 2003 and 2007. Sixty-one percent did not have surgery, 22% were treated with open reduction and internal fixation (ORIF), and 17% were treated with arthroplasty. RESULTS: The risk of an in hospital adverse event was 21% overall and was 4.4 times greater with arthroplasty and 2.7 times greater with ORIF compared to nonoperative treatment. The risk of in hospital death was 1.8% overall and was 2.8 times greater with ORIF compared to nonoperative treatment. Patients treated operatively were less likely to be discharged to a long-term facility compared to patients treated nonoperatively. CONCLUSION: In spite of a tendency to treat the most infirm patients (those that are not discharged to home) nonoperatively, operative treatment (open reduction and internal fixation in particular) is an independent risk factor for inpatient adverse events and mortality in older-aged patients admitted to the hospital with an isolated fracture of the proximal humerus and should perhaps be offered more judiciously. LEVEL OF EVIDENCE: Level III, retrospective cohort study, treatment study.
Authors: John-Erik Bell; Brian C Leung; Kevin F Spratt; Ken J Koval; James D Weinstein; David C Goodman; Anna N A Tosteson Journal: J Bone Joint Surg Am Date: 2011-01-19 Impact factor: 5.284
Authors: John A Batsis; Jeanne M Huddleston; L Joseph Melton; Paul M Huddleston; Francisco Lopez-Jimenez; Dirk R Larson; Rachel E Gullerud; M Molly McMahon Journal: J Am Geriatr Soc Date: 2009-01-16 Impact factor: 5.562
Authors: Stavros G Memtsoudis; Alejandro González Della Valle; Melanie C Besculides; Licia Gaber; Thomas P Sculco Journal: Clin Orthop Relat Res Date: 2008-08-14 Impact factor: 4.176
Authors: Kenneth A Egol; Crispin C Ong; Michael Walsh; Laith M Jazrawi; Nirmal C Tejwani; Joseph D Zuckerman Journal: J Orthop Trauma Date: 2008-03 Impact factor: 2.512
Authors: Josef Stolberg-Stolberg; Jeanette Köppe; Robert Rischen; Moritz Freistühler; Andreas Faldum; J Christoph Katthagen; Michael J Raschke Journal: Dtsch Arztebl Int Date: 2021-12-03 Impact factor: 5.594
Authors: Jeanette Köppe; Josef Stolberg-Stolberg; Robert Rischen; Andreas Faldum; Michael J Raschke; J Christoph Katthagen Journal: Clin Orthop Relat Res Date: 2021-10-01 Impact factor: 4.755
Authors: Anant Dixit; Frank S Cautela; Colin S Cooper; George A Beyer; James C Messina; Jeffrey E Mait; Neil V Shah; Bassel G Diebo; Carl B Paulino; William P Urban Journal: J Orthop Traumatol Date: 2018-08-22