Morbidity, mortality and cost of osteoporotic fractures—should proximal humerus fractures be taken as seriously as hip fractures?

Eck, Carola F. van; Klein, Christopher C.; Rahmi, Hithem; Scheidt, Karl B.; Schultzel, Mark; Lee, Brian K.; Itamura, John M.

doi:10.21037/aoj.2019.01.01

Cited by 12 publications

(7 citation statements)

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“… 26 PHFs have been found to carry similar morbidity and mortality as compared with the hip fracture population. 8 Optimal treatment for these fractures is the topic of much continued debate, with hundreds of studies comparing various surgical and nonoperative methodologies. 24 , 27 , 28 , 31 , 46 , 47 , 48 , 52 , 55 , 56 , 60 , 65 , 67 , 69 …”

Section: Discussionmentioning

confidence: 99%

Use of a 5-item modified Fragility Index for risk stratification in patients undergoing surgical management of proximal humerus fractures

Evans¹,

Saltzman²,

Anastasio³

et al. 2021

JSES International

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Hypothesis We hypothesized that the modified Fragility Index (mFI) would predict complications in patients older than 50 years who underwent operative intervention for a proximal humerus fracture. Methods We retrospectively reviewed the American College of Surgeons National Surgery Quality Improvement Program database, including patients older than 50 years who underwent open reduction and internal fixation of a proximal humerus fracture. A 5-item mFI score was then calculated for each patient. Postoperative complications, readmission and reoperation rates as well as length of stay (LOS) were recorded. Univariate as well as multivariable statistical analyses were performed, controlling for age, sex, body mass index, LOS, and operative time. Results We identified 2,004 patients (median age, 66 years; interquartile range: 59-74), of which 76.2% were female. As mFI increased from 0 to 2 or greater, 30-day readmission rate increased from 2.8% to 6.7% ( P -value = .005), rate of discharge to rehabilitation facility increased from 7.1% to 25.3% ( P -value < .001), and rates of any complication increased from 6.5% to 13.9% ( P -value < .001). Specifically, the rates of renal and hematologic complications increased significantly in patients with mFI of 2 or greater ( P -value = .042 and P -value < .001, respectively). Compared with patients with mFI of 0, patients with mFI of 2 or greater were 2 times more likely to be readmitted within 30 days (odds ratio = 2.2, P -value .026). In addition, patients with mFI of 2 or greater had an increased odds of discharge to a rehabilitation center (odds ratio = 2.3, P -value < .001). However, increased fragility was not significantly associated with an increased odds of 30-day reoperation or any complication after controlling for demographic data, LOS, and operative time. Conclusion An increasing level of fragility is predictive of readmission and discharge to a rehabilitation center after open reduction and internal fixation of proximal humerus fractures. Our data suggest that a simple fragility evaluation can help inform surgical decision-making and counseling in patients older than 50 years with proximal humerus fractures.

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Section: Discussionmentioning

confidence: 99%

Use of a 5-item modified Fragility Index for risk stratification in patients undergoing surgical management of proximal humerus fractures

Evans¹,

Saltzman²,

Anastasio³

et al. 2021

JSES International

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“…Thus it should trigger a work-up for nutritional status. The potential pre-operative optimization period is in contrast to hip fractures which often require urgent care within 24 h [20, 25]. In consideration of our findings and the flexible pre-operative period of proximal humerus fractures, there may be future studies to evaluate the effect of pre-operative nutrition modification on post-operative complications.…”

Section: Discussionmentioning

confidence: 99%

“…This is presumably through the increased rates of discharge to extended care and 90-day emergency room visits. These fractures represent a significant financial burden in health care, amassing similar costs of care as other osteoporotic fractures such as distal radius, hip and vertebral compression fractures [25]. Overall incidence and cost is likely to increase in the current at risk aging demographic [21, 26].…”

Section: Discussionmentioning

confidence: 99%

Pre-operative Hypoalbuminemia is Associated with Complications following Proximal Humerus Fracture Surgery: An Analysis of 919 Patients

Althoff

Ignozzi

Bell

et al. 2020

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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Background Proximal humerus fractures are among the most common presenting fractures to orthopedic surgeons in the USA. Hypoalbuminemia is accepted as a nutrition marker associated with post-operative complications following common orthopedic interventions. Questions/Purposes Thus, the authors sought to (1) describe the national demographic trends of patients undergoing surgical fixation for proximal humerus fracture and (2) investigate the association between pre-operative hypoalbuminemia, a malnutrition marker, and post-operative complications within 1 year of surgical intervention. Methods The PearlDiver Humana Claims Database was queried to identify a nationally representative cohort of patients who underwent surgical intervention for proximal humerus fractures from 2008 to 2015. Demographic and comorbid characteristics were collected. Pearson's χ-squared analysis was used to compare rates of 90-day and 1-year outcomes between hypoalbuminemia (albumin ≤ 3.5 mg/dL) and control groups. Multivariate logistic regression was then used to determine the isolated effect that hypoalbuminemia had on post-operative outcomes. Results Of the 3337 patients identified, 919 (27.5%) had available serum albumin data. Seventy (7.6%) patients had hypoalbuminemia. Hypoalbuminemia was more likely to be associated with post-operative sepsis (7.1% vs. 1.5%, respectively) and pneumonia (15.7% vs. 4.6) compared with controls. Additionally, hypoalbuminemia was associated with increased 90-day rates of discharge to extended care (4.3% vs. 0.8), emergency room visits (38.6% vs. 21.7), and total cost ($24,051.96 ± 24,972.74 vs. $15,429.74 ± 24,492.30). Conclusion Our study suggests hypoalbuminemia is associated with an increased risk of complications, specifically pneumonia and sepsis, and total health care costs in patients undergoing surgery for proximal humerus fractures. These findings provide insight for individualized patient care that will aid in evaluating the potential risk of surgical complications in an effort to improve outcomes and reduce costs.

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“…Osteoporotic fractures are associated with mortality rates above those of the general population ranging from 1% during the initial admission to 10% at a year following the fracture. 64,65 Patients who live at nursing homes are at higher risk of mortality than those who live in their own homes. 65 Although no specific protocols exist, the early involvement of a physician is recommended on admission to assist with the medical care of patients with PHFs.…”

Section: Mortalitymentioning

confidence: 99%

“…64,65 Patients who live at nursing homes are at higher risk of mortality than those who live in their own homes. 65 Although no specific protocols exist, the early involvement of a physician is recommended on admission to assist with the medical care of patients with PHFs.…”

Section: Mortalitymentioning

confidence: 99%

Proximal humerus fractures - Part 1: Conservative management

et al. 2019

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Fractures of the proximal humerus are common, especially in osteoporotic females. Despite this, there remains significant debate around their preferred treatment. The difficulties when considering treatment options is the wide array of fracture patterns and multiple patient factors which play an important role in the outcome of the management of these fractures. Fortunately, the vast majority of these fractures can be treated conservatively. The challenge, however, is the 15% of patients in which surgery may be required such as displaced three-and four-part fractures, and fractures in young and active patients. Although various recent studies and review papers show acceptable results with conservative treatment, especially in elderly patients, the decision on when to operate and when to consider conservative treatment remains challenging. The goal of this current concepts paper is to highlight important aspects of the conservative management of patients with proximal humerus fractures, from initial assessment through to treatment, including possible complications.

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Morbidity, mortality and cost of osteoporotic fractures—should proximal humerus fractures be taken as seriously as hip fractures?

Cited by 12 publications

References 0 publications

Use of a 5-item modified Fragility Index for risk stratification in patients undergoing surgical management of proximal humerus fractures

Use of a 5-item modified Fragility Index for risk stratification in patients undergoing surgical management of proximal humerus fractures

Pre-operative Hypoalbuminemia is Associated with Complications following Proximal Humerus Fracture Surgery: An Analysis of 919 Patients

Proximal humerus fractures - Part 1: Conservative management

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