Abstract：
BACKGROUND: Proximal humerus fracture (PHF) is a risk factor for 1-year mortality. This study aimed to determine if surgery is associated with lower mortality compared to nonoperative treatment following PHF in older patients.
METHODS: This retrospective cohort study used the Medicare Limited Data set. Patients aged 65 years and older with a PHF diagnosis in 2017-2020 were included. Treatment was classified as nonoperative, open reduction internal fixation (ORIF), total shoulder arthroplasty (TSA), or hemiarthroplasty. Multivariable logistic regression models examined (a) predictors of treatment type and (b) the association of treatment type with 1-year mortality, adjusting for patient demographics, comorbidities, frailty, and fracture severity among other variables. A subgroup analysis examined how the relationship between treatment type and 1-year mortality varied based on fracture severity. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) are reported.
RESULTS: In total, 49,072 patients were included (mean age = 76.6 years, 82.3% female). Most were treated nonoperatively (77.5%), 10.9% underwent ORIF, 10.6% underwent TSA, and 1.0% underwent hemiarthroplasty. Examples of factors associated with receipt of operative (versus nonoperative treatment) included worse fracture severity and lower frailty. The 1-year mortality rate after the initial PHF diagnosis was 11.0% for the nonoperative group, 4.0% for ORIF, 5.2% for TSA, and 6.0% for hemiarthroplasty. Compared to nonoperative treatment, ORIF (aOR 0.55; 95% CI [0.47, 0.64]; P < .001) and TSA (aOR 0.59; 95% CI [0.50, 0.68]; P < .001) were associated with decreased odds of 1-year mortality. In the subgroup analysis, ORIF and TSA were associated with a lower 1-year mortality risk for 2-part and 3-/4-part fractures.
CONCLUSIONS: Compared to nonoperative treatment, surgery (particularly TSA and ORIF) was associated with a decreased odds of 1-year mortality. This relationship remained significant for 2-part and 3-/4-part fractures after stratifying by fracture severity.
METHODS: This retrospective cohort study used the Medicare Limited Data set. Patients aged 65 years and older with a PHF diagnosis in 2017-2020 were included. Treatment was classified as nonoperative, open reduction internal fixation (ORIF), total shoulder arthroplasty (TSA), or hemiarthroplasty. Multivariable logistic regression models examined (a) predictors of treatment type and (b) the association of treatment type with 1-year mortality, adjusting for patient demographics, comorbidities, frailty, and fracture severity among other variables. A subgroup analysis examined how the relationship between treatment type and 1-year mortality varied based on fracture severity. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) are reported.
RESULTS: In total, 49,072 patients were included (mean age = 76.6 years, 82.3% female). Most were treated nonoperatively (77.5%), 10.9% underwent ORIF, 10.6% underwent TSA, and 1.0% underwent hemiarthroplasty. Examples of factors associated with receipt of operative (versus nonoperative treatment) included worse fracture severity and lower frailty. The 1-year mortality rate after the initial PHF diagnosis was 11.0% for the nonoperative group, 4.0% for ORIF, 5.2% for TSA, and 6.0% for hemiarthroplasty. Compared to nonoperative treatment, ORIF (aOR 0.55; 95% CI [0.47, 0.64]; P < .001) and TSA (aOR 0.59; 95% CI [0.50, 0.68]; P < .001) were associated with decreased odds of 1-year mortality. In the subgroup analysis, ORIF and TSA were associated with a lower 1-year mortality risk for 2-part and 3-/4-part fractures.
CONCLUSIONS: Compared to nonoperative treatment, surgery (particularly TSA and ORIF) was associated with a decreased odds of 1-year mortality. This relationship remained significant for 2-part and 3-/4-part fractures after stratifying by fracture severity.
摘要：
背景：肱骨近端骨折（PHF）是1年死亡率的危险因素。这项研究旨在确定在老年患者中，与PHF后的非手术治疗相比，手术是否与较低的死亡率相关。
方法：这项回顾性队列研究使用了MedicareLimited数据集。纳入2017-2020年诊断为PHF的65岁以上患者。治疗被归类为非手术，切开复位内固定(ORIF),全肩关节置换术（TSA），或者半髋关节置换术.多变量逻辑回归模型检查了（a）治疗类型的预测因素和（b）治疗类型与1年死亡率的关系，根据患者的人口统计进行调整，合并症,脆弱,和骨折严重程度等变量。亚组分析检查了治疗类型与1年死亡率之间的关系如何根据骨折严重程度而变化。报告了调整后的比值比(aOR)和95%置信区间(CI)。
结果：总计，包括49,072例患者（平均年龄=76.6岁，82.3%女性)。大多数患者非手术治疗（77.5%），10.9%接受ORIF，10.6%接受了TSA,1.0%接受了半髋关节置换术。与接受手术治疗（相对于非手术治疗）相关的因素的例子包括骨折严重程度更差和虚弱程度更低。非手术组初次诊断PHF后1年死亡率为11.0%，ORIF为4.0%，TSA的5.2%，半髋关节置换术为6.0%。与非手术治疗相比，ORIF(aOR0.55;95%CI[0.47,0.64];P<.001)和TSA(aOR0.59;95%CI[0.50,0.68];P<.001)与1年死亡率降低相关。在亚组分析中，ORIF和TSA与2部分和3/4部分骨折的1年死亡风险较低相关。
结论：与非手术治疗相比，手术(特别是TSA和ORIF)与1年死亡率降低相关.根据骨折严重程度分层后，这种关系对于2部分和3/4部分骨折仍然很重要。
方法：这项回顾性队列研究使用了MedicareLimited数据集。纳入2017-2020年诊断为PHF的65岁以上患者。治疗被归类为非手术，切开复位内固定(ORIF),全肩关节置换术（TSA），或者半髋关节置换术.多变量逻辑回归模型检查了（a）治疗类型的预测因素和（b）治疗类型与1年死亡率的关系，根据患者的人口统计进行调整，合并症,脆弱,和骨折严重程度等变量。亚组分析检查了治疗类型与1年死亡率之间的关系如何根据骨折严重程度而变化。报告了调整后的比值比(aOR)和95%置信区间(CI)。
结果：总计，包括49,072例患者（平均年龄=76.6岁，82.3%女性)。大多数患者非手术治疗（77.5%），10.9%接受ORIF，10.6%接受了TSA,1.0%接受了半髋关节置换术。与接受手术治疗（相对于非手术治疗）相关的因素的例子包括骨折严重程度更差和虚弱程度更低。非手术组初次诊断PHF后1年死亡率为11.0%，ORIF为4.0%，TSA的5.2%，半髋关节置换术为6.0%。与非手术治疗相比，ORIF(aOR0.55;95%CI[0.47,0.64];P<.001)和TSA(aOR0.59;95%CI[0.50,0.68];P<.001)与1年死亡率降低相关。在亚组分析中，ORIF和TSA与2部分和3/4部分骨折的1年死亡风险较低相关。
结论：与非手术治疗相比，手术(特别是TSA和ORIF)与1年死亡率降低相关.根据骨折严重程度分层后，这种关系对于2部分和3/4部分骨折仍然很重要。
