背景:反向全肩关节成形术(rTSA)在肱骨近端骨折(PHF)的手术治疗中越来越受欢迎。这项研究的目的是比较切开复位内固定(ORIF)之间PHF手术治疗的种族差异,半髋关节置换术,和rTSA。我们的假设是,种族之间的固定没有差异。
方法:查询了国家外科质量改进计划(NSQIP)数据库中的ORIF,rTSA,以及2006年至2020年间PHF患者的半髋关节置换术。种族,种族,年龄,性别,体重指数(BMI),和美国麻醉医师协会(ASA)类被记录。进行卡方检验以评估患者因素与手术干预之间的关系。单变量分析中0.10水平显著的因素被纳入多变量多项模型以预测手术干预。
结果:7,499例患者接受了PHF的手术治疗,包括526(7%)进行半髋关节置换术,5,011(67%)正在接受ORIF,和1,962(26%)接受rTSA。27%的患有PHF的白人患者接受了rTSA,而21%的黑人患者接受了rTSA,16%的亚洲患者,14%的美洲原住民和阿拉斯加原住民患者(p<0.001)。在多变量分析中,rTSA的利用率随着时间的推移而增加(自2006年以来每年OR为1.2,p<0.001),半髋关节置换术的利用率随着时间的推移而下降(自2006年以来每年OR为0.86,p<0.001).与ORIF相比,非白人患者接受rTSA的几率显着降低(OR0.75,95%CI0.58-0.97),男性患者也是如此(OR0.77,95%CI0.66-0.88)。65岁以上的患者(OR3.86,95%CI3.39-4.38),ASA分级较高的患者(ASA2:OR3.24,95%CI1.86-5.66,ASA3:OR4.77,95%CI2.74-8.32,ASA4:OR5.25,95%CI2.89-9.54),超重(OR1.33,95%CI1.14-1.55)或肥胖(OR1.52,95%CI1.32-1.75)患者接受rTSA的几率高于ORIF.
结论:随着rTSA利用率的增加,了解PHF手术治疗的差异对于改善预后和公平获得新兴骨科技术至关重要.虽然患者因素如年龄,BMI,已知合并症会直接影响结果,因此可以预测手术干预的类型,患者种族不应该决定治疗。
BACKGROUND: Reverse total shoulder arthroplasty (rTSA) has gained popularity for the operative treatment of proximal humerus fractures (PHF). The purpose of this study was to compare racial differences in surgical management of PHF between open reduction and internal fixation (ORIF), hemiarthroplasty, and rTSA. Our hypothesis was that there would be no difference in fixation by race.
METHODS: The National Surgical Quality Improvement Program (NSQIP) database was queried for ORIF, rTSA, and hemiarthroplasty between 2006 and 2020 for patients with a PHF. Race, ethnicity, age, sex, body mass index (BMI), and American Society of Anesthesiologists (ASA) class were recorded. Chi squared tests were performed to assess relationships between patient factors and operative intervention. Factors significant at the 0.10 level in univariable analyses were included in a multivariable multinomial model to predict operative intervention.
RESULTS: 7,499 patients underwent surgical treatment for a PHF, including 526 (7%) undergoing hemiarthroplasty, 5,011 (67%) undergoing ORIF, and 1,962 (26%) undergoing rTSA. 27% of white patients with PHF underwent rTSA compared to 21% of Black patients, 16% of Asian patients, and 14% of Native American and Alaskan Native patients (p<0.001). In the multivariable analysis, utilization of rTSA increased over time (OR 1.2 per year since 2006, p < 0.001) and hemiarthroplasty decreased over time (OR 0.86 per year since 2006, p < 0.001). Non-white patients had significantly lower odds of undergoing rTSA versus ORIF (OR 0.75, 95% CI 0.58-0.97), as did male patients (OR 0.77, 95% CI 0.66-0.88). Patients over 65 (OR 3.86, 95% CI 3.39-4.38), patients with higher ASA classifications (ASA2: OR 3.24, 95% CI 1.86-5.66, ASA3: OR 4.77, 95% CI 2.74-8.32, ASA4: OR 5.25, 95% CI 2.89-9.54), and patients who were overweight (OR 1.33, 95% CI 1.14-1.55) or obese (OR 1.52, 95% CI 1.32-1.75) had higher odds of undergoing rTSA versus ORIF.
CONCLUSIONS: As utilization of rTSA increases, understanding disparities in surgical treatment of PHF is crucial to improving outcomes and equitable access to emerging orthopedic technologies. While patient factors such as age, BMI, and comorbidities are known to directly impact outcomes and thus may be predictive of the type of surgical intervention, patient race should not dictate treatment.