Mortality rates of humerus fractures in the elderly: Does surgical treatment matter?

• Authors: Sarah T. Lander, University of Rochester; Bilal Mahmood, University of Rochester; Michael Maceroli, Emory University; Jonathan Byrd, University of Rochester; John C. Elfar, Penn State College of Medicine; John P. Ketz, University of Rochester; Lucas E. Nikkel, Penn State College of Medicine
• Journal Title: Journal of Orthopaedic Trauma
• Volume: Volume 33, Number 7
• Publisher: (publisher) | 2019-01-01, Pages 361-365
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1097/BOT.0000000000001449
• Subjects: Health Sciences, Medicine and Surgery; Health Sciences, Public Health; Gerontology; Health Sciences, Human Development
• Keywords: Age Factors; Aged; Aged, 80 and over; Female; Fracture Fixation; Humans; Humeral Fractures; Male; Retrospective Studies; Risk Assessment; Risk Factors; Survival Rate; United States

Abstract

Introduction: Multiple studies have shown the impact of hip fractures on geriatric mortality. Few evaluate mortality after proximal humerus (PH) or distal humerus (DH) fractures, and fewer determine differences in mortality based on management. We aim to evaluate a statewide cohort of elderly patients with PH or DH fractures to evaluate mortality, length of stay, discharge data, readmission, and differences based on management. Methods The New York Statewide Planning and Research Cooperative System database was used to identify patients 60 years and older admitted with a PH or DH fracture. Patient demographics, including age, gender, sex, race, weight, and insurance status, along with comorbid conditions using the Charlson Comorbidity Index, were determined. Seven-day, 30-day, and 1-year mortality was determined for operative and nonoperative cohorts. Logistic regression determined the competing risk of mortality when controlling for patient demographics, comorbid conditions, and treatment. Results: Forty-two thousand five hundred eleven PH and 7654 DH fractures were evaluated. PH fractures had higher mortality than DH. Nonoperative treatment occurred in 76.2% of PH fractures and 53% of DH fractures. There were more comorbid conditions, longer length of stay, and higher mortality at 7 days, 30 days, and 1 year in patients treated nonoperatively. After controlling for patient demographics and comorbid conditions, there was no difference in mortality between PH and DH fractures, but operative treatment for either PH or DH was associated with lower mortality at all time points. Discussion: Fewer PH than DH fractures were treated operatively. Operative treatment was associated with improved survival in patients hospitalized with PH or DH fracture even after controlling for patient demographic and comorbid factors.Level of Evidence:Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.