Comorbidities, substance abuse, weight and age are independent risk factors for postoperative complications following operation for proximal humerus fractures: a retrospective analysis of 1109 patients

Abstract

Introduction This study aimed to investigate the influence of epidemiologic parameters on complications that needed operative revision of operatively treated proximal humerus fractures. Methods We performed a retrospective single-center study in a level 1 trauma center. We included all patients with operatively treated proximal humerus fractures from January 1 2005 to December 31 2015. We characterized our cohort and subgroup using descriptive statistics. The primary outcome was postoperative complications. For this purpose, postoperative complications were defined in advance, an operative revision was necessary on a general rule. The secondary outcome was a model of the risk factors for complications created with multiple logistic regression. Results We included 1109 patients. The average age was 67.2 years (± 16.4), and 71.4% of the fractures occurred in women. A total of 644 patients (58.1%) had between one to three comorbidities, and 27.8% had four or more. The fracture morphology was as follows: 3 part 41.8%, 4 part 26.9%, 2 part 24.3%, and dislocation fracture 6.7%. Complications occurred in 150 patients (13.5%). The number of comorbidities [odds ratio (OR) 2.85, p < 0.01], body weight (OR 1.15, p = 0.02), and substance abuse (OR 1.82, p = 0.04) significantly correlated with the risk of complications. We achieved a sensitivity of 48% and a specificity of 74% for the variables body weight, substance abuse, age, and comorbidities Conclusion The epidemiologic parameters, comorbidities, substance abuse, weight, and age are independent risk factors for complications. If these factors are present, one can predict a postoperative complication requiring surgical revision with low sensitivity and moderate specificity. Therefore, concerning the high number of multi-morbid patients with proximal humerus fractures, an increased postoperative complication rate can be expected. Level of evidence Level of evidence IV

Assessment of Complication Risk in the Treatment of Proximal Humerus Fractures: A Retrospective Analysis of 4019 Patients

“…Most clinical outcome studies dealing with the treatment of proximal humeral fractures, regardless of whether retro-or prospective, have a single-center study design. The largest cohorts in the literature deal with about 1000 PHFs each [6,9]. When searching PubMed for [proximal humer* multicentric] in November 2022, 51 hits appeared.…”

“…Comorbidities were defined as apoplexy with residuals in the history, arterial hypertension, asthma, congenital immune defects, chronic obstructive pulmonary disease (COPD), coronary heart disease, diabetes mellitus, emphysema, human immunodeficiency virus (HIV), kidney failure requiring dialysis, liver cirrhosis, pre-existing neurological conditions (e.g., multiple sclerosis), organ transplantation, rheumatic disease, or any type of tumor disease (counting a second tumor case as independent comorbidity). Substance abuse meant alcohol and/or drug abuse [9,10]. Alcohol or drug abuse was recorded as a parameter if it was diagnosed and reported at the time of treatment initiation of the proximal humerus fracture.…”

Das schulterspezifische Outcome nach proximaler Humerusfraktur hat Einfluss auf die mittelfristige allgemeine Lebensqualität

“…Because of this correlation, the indication for surgery should increasingly be made while taking into account patient-specific factors. It has already been shown that pre-existing conditions play a major role [40].…”

“…Aufgrund dieses Zusammenhanges sollte die Indikation zur Operation vermehrt auch unter Berücksichtigung patientenspezifischer Faktoren gestellt werden. Hierzu konnte bereits gezeigt werden, dass vor allem die Vorerkrankungen eine große Rolle spielen [40].…”