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Root KT, Burnett AJ, Kakalecik J, Harris AB, Ladehoff L, Taneja K, Patrick MR, Hagen JE, King JJ. The Association between Race and Extended Length of Stay in Low-energy Proximal Humerus Fractures in Elderly Patients. J Am Acad Orthop Surg 2024; 32:e759-e768. [PMID: 38595161 DOI: 10.5435/jaaos-d-23-00925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 02/19/2024] [Indexed: 04/11/2024] Open
Abstract
INTRODUCTION Proximal humerus fractures (PHFs) are one of the most common fractures among patients aged 65 years and older, commonly due to low-energy mechanisms. It is essential to identify drivers of increased healthcare utilization in geriatric PHF patients and bring awareness to any disparities in care. Here, we identify factors associated with the likelihood of inpatient admission and prolonged hospital stay among patients aged 65 years and older who sustain PHF due to falls. METHODS A national database was used to identify patients aged 65 years and older who suffered proximal humeral fractures due to a fall. Patient factors were analyzed for association with the likelihood of admission and odds of prolonged stay (≥5 days). RESULTS In the study period, 75,385 PHF patients who met our inclusion criteria presented to the emergency department and 14,118 (18.7%) were admitted. Black race was significantly associated with decreased odds of admission ( P < 0.001) and increased likelihood of prolonged stay ( P = 0.007) compared with White patients. Patients aged 75 to 84 and 85+ were both more likely to be admitted ( P < 0.001) and experienced a prolonged hospital stay ( P = 0.015). Patients undergoing surgical intervention with reverse total shoulder arthroplasty were associated with admission and prolonged length of stay ( P < 0.001). Hospitals in Midwestern ( P < 0.001) and Western ( P < 0.001) regions exhibited lower rates of admission and Northeastern hospitals were associated with prolonged stays ( P = 0.001). Finally, trauma and nonmetropolitan ( P < 0.001) centers were associated with admission. CONCLUSION Our study highlights the notable influence of age and race on the likelihood of hospital admission and prolonged hospital stay. Specifically, Black patients exhibited prolonged hospital stay, which has been associated with lower-quality care, warranting additional exploration. Understanding these demographic and hospital-related factors is essential for optimizing resource allocation and reducing healthcare disparities in the care of PHF patients, especially as the population ages and the incidence of PHF continues to rise.
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Affiliation(s)
- Kevin T Root
- From the College of Medicine, University of Florida, Gainesville, FL (Root and Burnett), Department of Orthopaedic Surgery, University of Florida, Gainesville, FL (Kakalecik, Patrick, Hagen, and King), the Department of Orthopaedic Surgery, Johns Hopkins, Baltimore, MD (Harris), USF Health Morsani College of Medicine, Tampa, FL (Ladehoff), and Renaissance School of Medicine at Stony Brook University, Stony Brook, NY (Taneja)
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McDonald BR, Vogrin S, Said CM. Factors affecting hospital admission, hospital length of stay and new discharge destination post proximal humeral fracture: a retrospective audit. BMC Geriatr 2024; 24:334. [PMID: 38609852 PMCID: PMC11015557 DOI: 10.1186/s12877-024-04928-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 03/28/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Outcomes following proximal humeral fracture (PHF) may be impacted by a range of clinical, fracture and premorbid factors. The aim of this study was to examine factors impacting hospital admission; length of stay (LOS) and new discharge destination for patients presenting to hospital with PHF. METHODS Retrospective audit conducted at a tertiary health service. Data was collected from adult patients presenting to hospital with a PHF over a 54-month period. Fractures that were pathological or sustained during admission were excluded. Univariable and multivariable logistic and negative binomial regression were used to explore factors associated with hospital admission, LOS and new discharge destination. RESULTS Data were analyzed from 701 participants (age 70 years (IQR 60, 81); 72.8% female); 276 (39.4%) participants required a hospital admission. New discharge destination was required for 109 (15.5%) participants, of whom 49 (45%) changed from home alone to home with family/friend(s). Greater comorbidities, as indicated by the Charlson Comorbidity Index score, were associated with hospital admission, longer LOS and new discharge destination. Premorbid living situations of home with family/friend(s) or from an external care facility were associated with a decreased likelihood of hospital admission, shorter LOS and reduced risk of a new discharge destination. Surgical treatment was associated with shorter LOS. Older age and dementia diagnosis were associated with a new discharge destination. CONCLUSIONS Many factors potentially impact on the likelihood or risk of hospitalization, LOS and new discharge destination post PHF. Patients with greater comorbidities are more likely to have negative outcomes, while patients who had premorbid living situations of home with family/friend(s) or from an external care facility are more likely to have positive outcomes. Early identification of factors that may impact patient outcomes may assist timely decision making in hospital settings. Further research should focus on developing tools to predict hospital outcomes in the PHF population.
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Affiliation(s)
- B R McDonald
- Department of Physiotherapy, Western Health, St Albans, VIC, Australia
- The University of Melbourne, Parkville, VIC, Australia
| | - S Vogrin
- The University of Melbourne, Parkville, VIC, Australia
- Australian Institute for Musculoskeletal Science, St Alban, VIC, Australia
- Department of Medicine, Western Health, St Albans, VIC, Australia
| | - C M Said
- Department of Physiotherapy, Western Health, St Albans, VIC, Australia.
- The University of Melbourne, Parkville, VIC, Australia.
- Australian Institute for Musculoskeletal Science, St Alban, VIC, Australia.
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Shi BY, Upfill-Brown A, Kelley BV, Brodke DJ, Mayer EN, Devana SK, Kremen TJ, Lee C. Increasing Rate of Shoulder Arthroplasty for Geriatric Proximal Humerus Fractures in the United States, 2010–2019. J Shoulder Elb Arthroplast 2022; 6:24715492221137186. [PMID: 36419867 PMCID: PMC9677166 DOI: 10.1177/24715492221137186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/07/2022] [Accepted: 10/19/2022] [Indexed: 08/11/2023] Open
Abstract
Introduction The two historically dominant surgical options for displaced geriatric proximal humerus (PHFx) fractures are open reduction internal fixation (ORIF) and hemiarthroplasty (HA). However, shoulder arthroplasty (SA), predominantly in the form of reverse total shoulder arthroplasty (RTSA), has emerged as an attractive treatment option. We aim to compare the utilization trends, complications, and costs associated with surgical management of geriatric proximal humerus fractures (PHFs) between 2010 and 2019. We hypothesized that 1) the proportion of patients undergoing SA would increase over time, 2) the short-term complication rate in patients undergoing SA would decline over time, and 3) hospital related costs would decline for SA patients over time. Patients and Methods The National Inpatient Sample was queried from 2010 to 2019 to identify all PHFx in patients aged 65 or older that underwent ORIF, SA, or HA. Multivariable regression was used to evaluate differences between fixation methods regarding health care utilization metrics, hospital costs, and index hospital complications. The primary outcome of interest was the method of surgical management utilized in the treatment of geriatric PHFs, and secondary outcomes of interest included hospitalization cost, length of stay (LOS), discharge destination and index hospitalization complications. Results A total of 105 886 geriatric patients that underwent surgical management of PHFx were identified. While the proportion undergoing ORIF decreased from 59% to 29%, the proportion undergoing SA increased from 9% to 67%. Hospital costs decreased over time for patients treated with SA and increased for those treated with ORIF. Compared to ORIF, SA was associated with higher cost, decreased length of stay, and lower mortality and complication rates. Conclusion Over the last decade, SA has become the most common surgical treatment modality performed for geriatric PHFx. Index hospital complications are reduced in SA patients compared to ORIF patients, driven largely by a lower rate of blood transfusion. Although costs are decreasing and average length of stay is now lower in SA patients compared to ORIF patients, SA remains associated with higher hospital costs overall.
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Affiliation(s)
- Brendan Y Shi
- Department of Orthopaedic Surgery, University of California Los Angeles, Santa Monica, CA, USA
| | - Alexander Upfill-Brown
- Department of Orthopaedic Surgery, University of California Los Angeles, Santa Monica, CA, USA
| | - Benjamin V Kelley
- Department of Orthopaedic Surgery, University of California Los Angeles, Santa Monica, CA, USA
| | - Dane J Brodke
- Department of Orthopaedic Surgery, University of California Los Angeles, Santa Monica, CA, USA
| | - Erik N Mayer
- Department of Orthopaedic Surgery, University of California Los Angeles, Santa Monica, CA, USA
| | - Sai K Devana
- Department of Orthopaedic Surgery, University of California Los Angeles, Santa Monica, CA, USA
| | - Thomas J Kremen
- Department of Orthopaedic Surgery, University of California Los Angeles, Santa Monica, CA, USA
| | - Christopher Lee
- Department of Orthopaedic Surgery, University of California Los Angeles, Santa Monica, CA, USA
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Filho GDRM, Amaral MVG. Shoulder Arthroplasty for the Treatment of Proximal Humeral Fractures: Current Concepts. Rev Bras Ortop 2022; 57:529-539. [PMID: 35966425 PMCID: PMC9365482 DOI: 10.1055/s-0040-1721359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 09/16/2020] [Indexed: 11/28/2022] Open
Abstract
Complex proximal humeral fractures, especially in elderly patients, often require arthroplastic surgical treatment. Traditionally, shoulder hemiarthroplasty (HA) is the method of choice, resulting in long implant survival and a painless shoulder; however, shoulder HA has heterogeneous clinical outcomes related to the correct position of the implant, both in terms of height and version, and the anatomical consolidation of tuberosities. Today, reverse shoulder arthroplasties are increasingly used to treat such fractures. These techniques result in better functional outcomes compared to HAs, especially regarding anterior flexion, but implant longevity has not been established. The development of specific prosthetic humeral components for the treatment of fractures, which were recently introduced in the clinical practice, led to better clinical outcomes.
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Affiliation(s)
- Geraldo da Rocha Motta Filho
- Centro de Cirurgia do Ombro e Cotovelo, Instituto Nacional de Traumatologia e Ortopedia (INTO), Rio de Janeiro, RJ, Brasil
| | - Marcus Vinícius Galvão Amaral
- Centro de Cirurgia do Ombro e Cotovelo, Instituto Nacional de Traumatologia e Ortopedia (INTO), Rio de Janeiro, RJ, Brasil
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Comparison of 30-day complications between reverse shoulder arthroplasty and open reduction internal fixation for the treatment of proximal humerus fractures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2022; 33:1117-1124. [PMID: 35429276 DOI: 10.1007/s00590-022-03260-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 03/28/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE While the use of open reduction internal fixation (ORIF) has remained stable over the last decade, there has been a significant increase in the use of reverse total shoulder arthroplasty (RTSA) for proximal humerus fractures (PHFs). This study sought to compare the complication profiles of RTSA to ORIF in a large, validated, retrospective cohort. METHODS Patients who underwent surgical treatment for PHFs with RTSA or ORIF were identified in a national database (NSQIP) using CPT and ICD codes. Demographics and comorbidities were identified for each cohort of patients. Thirty-day complications were analyzed with univariate and multivariate analyses using Chi-square, Fischer's exact and analysis of variance testing. RESULTS The total number of patients included in this study was 2157.522 (24.2%) underwent RTSA and 1635 (75.8%) underwent ORIF. Patients undergoing RTSA were older with an average age of 73.52 years compared with 63.84 years in those undergoing ORIF (p < 0.001). Patients with RTSA were more likely to experience any complications (p < 0.001), pulmonary complications (p = 0.029), extended length of stay > 3 days (p < 0.001), and perioperative transfusion requirement (p < 0.001) after univariate analysis. After controlling for demographic differences, the only statistically significant complication was perioperative transfusion requirement (OR 1.383). CONCLUSION After controlling for demographic variables and comorbidities, RTSA placed patients at increased risk for perioperative blood transfusion. Patients undergoing RTSA should be counseled prior to surgery regarding the risk for transfusion and potentially optimized medically through multidisciplinary care if the surgeon elects to proceed with RTSA versus ORIF for the treatment of PHFs.
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Outcome of geriatric proximal humeral fractures: a comparison between reverse shoulder arthroplasty versus open reduction and internal fixation. OTA Int 2022; 5:e188. [PMID: 35949265 PMCID: PMC9359012 DOI: 10.1097/oi9.0000000000000188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/18/2021] [Indexed: 11/25/2022]
Abstract
Objectives: In view of the increased attention to reverse shoulder arthroplasty (rTSA) as a treatment for complex proximal humeral fractures in the elderly, the present study analyzes in-hospital complications and the postoperative management of rTSA versus open reduction and internal fixation (ORIF). Methods: We retrospectively reviewed patients hospitalized from 2016 to 2018 for proximal humeral fractures (ICD-9 codes: S42.21), III- and IV-part, who underwent an ORIF with locking plates, rTSA or nonoperative treatment. In-hospital complications and postoperative management in both groups were included in the analysis. Results: We included n 190 patients (ORIF 90, rTSA 71, nonoperative 29), more likely to be female (82.1% vs 17.9%; P < .01) with an average age of 82years (min. 72, max. 99; SD 6.4). The ORIF and the rTSA groups showed comparable complication rates (15.6% vs 15%, P = .87) but with a significantly shorter hospital stay (8.6 vs 11.5days; P = .01) and shorter duration of surgery (72.9 vs 87.2 minutes; P = .01) in the ORIF group. Significantly more patients after ORIF achieved an independent life postoperatively (53.3% vs 40.8%; P = .013). Conclusions: In this retrospective analysis, ORIF is related to a shorter duration of surgery, a shorter hospital stay and a higher likelihood of independence. Despite the popularity of the rTSA, ORIF remains a reliable treatment option for proximal humeral fractures in the elderly. Level of evidence: III
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Sheng H, Xu W, Xu B, Song H, Lu D, Ding W, Mildredl H. Application of Intelligent Computer-Assisted Taylor 3D External Fixation in the Treatment of Tibiofibular Fracture: Retrospective Case Study. JMIR Med Inform 2021; 9:e21455. [PMID: 33988516 PMCID: PMC8164113 DOI: 10.2196/21455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 06/26/2020] [Accepted: 06/27/2020] [Indexed: 11/13/2022] Open
Abstract
Background With the development of modern society, severe and complex tibial fractures caused by high-energy injuries such as traffic accidents have gradually increased. At present, the commonly used methods for the treatment of tibial fractures include plate fixation, intramedullary nail fixation, and external fixation. Most of these fractures are open wounds with severe soft tissue injury and wound contamination, and some involve bone defects, which makes internal fixation treatment difficult. Objective This study aims to explore the use of intelligent computer-assisted Taylor 3D external fixation for the treatment of tibiofibular fractures. Methods In total, 70 patients were included and divided into the Taylor 3D external fixation (TSF) group (28 patients with severe tibial fractures treated with TSF) and the internal fixation group (42 patients with complicated tibiofibular fractures treated by internal fixation). After the treatment, the follow-up evaluation of TSF for the treatment of tibiofibular fractures noted the incidence of complications, as well as the efficacy and occurrence of internal fixation for the treatment of tibial fractures in our hospital. Results The results showed that TSF was superior to orthopedics in the treatment of tibiofibular fractures in terms of efficacy and complications. Conclusions TSF for the treatment of tibiofibular fractures is more effective than internal fixation and the incidence of complications is low. This is a new technology for the treatment of tibiofibular fractures that is worthy of clinical promotion.
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Affiliation(s)
- Hongfeng Sheng
- Department of Orthopaedics, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Weixing Xu
- Department of Orthopaedics, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Bin Xu
- Department of Orthopaedics, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Hongpu Song
- Department of Orthopaedics, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Di Lu
- Department of Orthopaedics, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Weiguo Ding
- Department of Orthopaedics, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Henry Mildredl
- Federal Institute for Drugs and Medical Devices, Medical Devices Division, Bonn, Germany
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Impact of Increasing Comorbidity Burden on Resource Utilization in Patients With Proximal Humerus Fractures. J Am Acad Orthop Surg 2020; 28:e954-e961. [PMID: 32044822 DOI: 10.5435/jaaos-d-19-00491] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Proximal humerus fractures (PHF) are a common upper extremity fracture in the elderly cohort. An aging and more comorbid cohort, along with recent trends of increased operative intervention, suggests that there could be an increase in resource utilization caring for these patients. We sought to quantify these trends and quantify the impact that comorbidity burden has on resource utilization. METHODS Data on 83,975 patients with PHFs were included from the Premier Healthcare Claims database (2006 to 2016) and stratified by Deyo-Charlson index. Multivariable models assessed associations between Deyo-Charlson comorbidities and resource utilization (length and cost of hospitalization, and opioid utilization in oral morphine equivalents [OME]) for five treatment modalities: (1) open reduction internal fixation (ORIF), (2) closed reduction internal fixation (CRIF), (3) hemiarthroplasty, (4) reverse total shoulder arthroplasty, and (5) nonsurgical treatment (NST). We report a percentage change in resource utilization associated with an increasing comorbidity burden. RESULTS Overall distribution of treatment modalities was (proportion in percent/median length of stay/cost/opioid utilization): ORIF (19.1%/2 days/$11,183/210 OME), CRIF (1.1%/4 days/$11,139/220 OME), hemiarthroplasty (10.7%/3 days/$17,255/275 OME), reverse total shoulder arthroplasty (6.4%/3 days/$21,486/230 OME), and NST (62.7%/0 days/$1,269/30 OME). Patients with an increased comorbidity burden showed a pattern of (1) more pronounced relative increases in length of stay among those treated operatively (65.0% for patients with a Deyo-Charlson index >2), whereas (2) increases in cost of hospitalization (60.1%) and opioid utilization (37.0%) were more pronounced in the NST group. DISCUSSION In patients with PHFs, increased comorbidity burden coincides with substantial increases in resource utilization in patients receiving surgical and NSTs. Combined with known increases in operative intervention, trends in increased comorbidity burden may have profound effects on the cohort level and resource utilization for those with PHFs, especially because the use of bundled payment strategies for fractures increases. LEVEL OF EVIDENCE Level III.
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Maugendre E, Gadisseux B, Chantelot C, Clavert P, Ramdane N, Werthel JD, Boileau P. Epidemiology and mortality in older patients treated by reverse shoulder arthroplasty for displaced proximal humerus fractures. Orthop Traumatol Surg Res 2019; 105:1509-1513. [PMID: 31732395 DOI: 10.1016/j.otsr.2019.07.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 06/27/2019] [Accepted: 07/16/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Reverse shoulder arthroplasty (RSA) is rapidly becoming the preferred treatment for displaced proximal humerus fractures in older patients. However, few studies have analyzed the target population and the effect of RSA on survival, although the socioeconomic impact of this type of surgery is considerable. PATIENTS AND METHODS This was a retrospective epidemiological study of all patients with a displaced proximal humeral fracture treated by RSA in 14 public and private hospitals throughout France between 1995 and 2016. The French hospital discharge database (PMSI) was analyzed to isolate an 898-patient cohort who underwent RSA within 6 weeks of the fracture event. In 87% of cases, this was a 3- or 4-fragment fracture. We analyzed the epidemiological characteristics of the patients at the time of fracture, their survival (Kaplan-Meier estimate) and factors that may impact survival. RESULTS The mean age at the time of fracture and surgery was 79 years (46-98 years). Eighty percent of the cohort was female (sex ratio: 0.18 [p=0.0042], with 21% obesity rate [BMI>30]) and 60% of patients were ASA 1-2. The most common comorbidities were cardiovascular and neurological. The survival rate after RSA was 94% at 1 year and 73% at 5years. At the latest follow-up of 19 years, 42% of patients were still alive. In 18% of cases, the patient died within the first 15 days. The presence of comorbidities (ASA score>3-4) (p<0.004) and/or cognitive disorders (p<0.0001) were risk factors for early mortality. The time to surgery, type of fracture, associated fractures and discharge destination (return home, transfer to nursing home) had no effect on postoperative mortality in our cohort. CONCLUSION Despite being older (79 years) at the time of proximal humerus fracture, patients who underwent RSA treatment had a high survival rate (94% at 1 year, 73% at 5years), which is better than the survivorship reported after surgical treatment of femoral neck fractures (81-87% at 1 year, 38% at 5years). The presence of comorbidities (ASA>3-4) and/or cognitive disorders are risk factors for early mortality and should be taken into account to prevent early death. LEVEL OF EVIDENCE IV, Retrospective study.
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Affiliation(s)
- Emmanuel Maugendre
- Service de traumatologie, CHRU de Lille, hôpital Roger Salengro, 2, avenue Oscar-Lambret, 59037 Lille, France
| | - Benjamin Gadisseux
- Service de traumatologie, CHRU de Lille, hôpital Roger Salengro, 2, avenue Oscar-Lambret, 59037 Lille, France
| | - Christophe Chantelot
- Service de traumatologie, CHRU de Lille, hôpital Roger Salengro, 2, avenue Oscar-Lambret, 59037 Lille, France
| | - Philippe Clavert
- Service d'orthopédie-traumatologie, centre de chirurgie orthopédique et de la main, service de chirurgie orthopédique, avenue Baumann, 67400 Illkirch, France
| | - Nassima Ramdane
- EA 2694 - santé publique: épidémiologie et qualité des soins, université de Lille, CHU de Lille, 59000 Lille, France
| | - Jean-David Werthel
- Hôpital Ambroise-Paré Paris, 9, avenue Charles-de-Gaulle, 92104 Boulogne-Billancourt, France
| | - Pascal Boileau
- iULS - Institut universitaire locomoteur and sport, CHU de Nice, hôpital Pasteur 2, 30, voie Romaine, 06000 Nice, France.
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- Société française de chirurgie orthopédique et traumatologique, 56, rue Boissonade, 75014 Paris, France
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Mellstrand Navarro C, Brolund A, Ekholm C, Heintz E, Hoxha Ekström E, Josefsson PO, Leander L, Nordström P, Zidén L, Stenström K. Treatment of humerus fractures in the elderly: A systematic review covering effectiveness, safety, economic aspects and evolution of practice. PLoS One 2018; 13:e0207815. [PMID: 30543644 PMCID: PMC6292626 DOI: 10.1371/journal.pone.0207815] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 11/05/2018] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES The objective of this Health Technology Assessment was to evaluate effectiveness, complications and cost-effectiveness of surgical or non-surgical treatment for proximal, diaphyseal or distal fractures of the humerus in elderly patients. Secondary objectives were to evaluate the intervention costs per treatment of proximal humerus fractures (PHF) and to investigate treatment traditions of PHF in Sweden. METHODS AND FINDINGS The assessment contains a systematic review of clinical and health economic studies comparing treatment options for humerus fractures in elderly patients. The results regarding the effectiveness of treatments are summarized in meta-analyses. The assessment also includes a cost analysis for treatment options and an analysis of registry data of PHF. For hemiarthroplasty (HA) and non-operative treatment, there was no clinically important difference for moderately displaced PHF at one-year follow-up regarding patient rated outcomes, (standardized mean difference [SMD]) -0.17 (95% CI: -0.56; 0.23). The intervention cost for HA was at least USD 5500 higher than non-surgical treatment. The trend in Sweden is that surgical treatment of PHF is increasing. When functional outcome of percutaneous fixation/plate fixation/prosthesis surgery and non-surgical treatment was compared for PHF there were no clinically relevant differences, SMD -0.05 (95% CI: -0.26; 0.15). There was not enough data for interpretation of quality of life or complications. Evidence was scarce regarding comparisons of different surgical options for humerus fracture treatment. The cost of plate fixation of a PHF was at least USD 3900 higher than non-surgical treatment, costs for complications excluded. In Sweden the incidence of plate fixation of PHF increased between 2005 and 2011. CONCLUSIONS There is moderate/low certainty of evidence that surgical treatment of moderately displaced PHF in elderly patients has not been proven to be superior to less costly non-surgical treatment options. Further research of humerus fractures is likely to have an important impact.
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Affiliation(s)
- Cecilia Mellstrand Navarro
- Department of Hand Surgery, Karolinska Institute, Institution for Clinical Research and Education, Södersjukhuset Hospital, Stockholm, Sweden
| | - Agneta Brolund
- Swedish Agency for Health Technology Assessment and Assessment of Social Services, Stockholm, Sweden
| | - Carl Ekholm
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Mölndal, Sweden
| | - Emelie Heintz
- Swedish Agency for Health Technology Assessment and Assessment of Social Services, Stockholm, Sweden
- Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| | - Emin Hoxha Ekström
- Swedish Agency for Health Technology Assessment and Assessment of Social Services, Stockholm, Sweden
| | | | - Lina Leander
- Swedish Agency for Health Technology Assessment and Assessment of Social Services, Stockholm, Sweden
| | - Peter Nordström
- Department of Community Medicine and Rehabilitation, Geriatrics, Umeå, Sweden
| | - Lena Zidén
- Department of Health and Rehabilitation, The Sahlgrenska Academy at the University of Gothenburg, Institute of Neuroscience and Physiology, Gothenburg, Sweden
| | - Karin Stenström
- Swedish Agency for Health Technology Assessment and Assessment of Social Services, Stockholm, Sweden
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Dixit A, Cautela FS, Cooper CS, Beyer GA, Messina JC, Mait JE, Shah NV, Diebo BG, Paulino CB, Urban WP. ORIF versus arthroplasty for open proximal humerus fractures: Nationwide Inpatient Sample data between 1998 and 2013. J Orthop Traumatol 2018; 19:12. [PMID: 30132086 PMCID: PMC6103959 DOI: 10.1186/s10195-018-0503-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 11/27/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Limited data exists in analyzing open reduction and internal fixation (ORIF) and arthroplasty in the management of open proximal humerus fractures. We analyzed differences in hospital course between these procedures, patient demographics, complication rate, length of stay, hospital charges, and mortality rate. MATERIALS AND METHODS This is a retrospective review of the Nationwide Inpatient Sample database. ICD-9 codes identified patients hospitalized for open proximal humerus fractures from 1998 to 2013 who underwent ORIF or shoulder arthroplasty (hemi-, total, or reverse). Demographics and in-hospital complications were compared. Logistic regression controlling for age, gender, and Deyo index tested the impact of ORIF vs ARTH on any complications. RESULTS Seven hundred thirty patients were included (ORIF, n = 662 vs ARTH, n = 68). ORIF patients were younger (p < 0.001), more likely to be males (p < 0.001), and had a lower Deyo score (p = 0.012). Both groups had comparable complication rates (21.4% vs 18.0%, p = 0.535), lengths of stay (7.86 days vs 7.44 days, p = 0.833), hospital charges ($76,998 vs $64,133, p = 0.360), and mortality rates (0.2% vs 0%, p = 0.761). Type of surgery was not a predictor of any complications (OR = 0.67 [95% CI 0.33-1.35], p = 0.266), extended length of stay (OR = 1.01 [95% CI 0.58-1.78], p = 0.967), or high hospital charges (OR = 1.39 [95% CI 0.68-2.86], p = 0.366). CONCLUSION We revealed no differences in hospital course between ORIF and arthroplasty for management of open proximal humerus fractures. Although differences in demographics existed, no differences in complication rates, length of stay, hospital charges and mortality rates were noted. Future studies can evaluate the long-term outcomes of these procedures. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Anant Dixit
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York, Downstate Medical Center, 450 Clarkson Avenue, Box 30, Brooklyn, NY, 11203, USA
| | - Frank S Cautela
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York, Downstate Medical Center, 450 Clarkson Avenue, Box 30, Brooklyn, NY, 11203, USA
| | - Colin S Cooper
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York, Downstate Medical Center, 450 Clarkson Avenue, Box 30, Brooklyn, NY, 11203, USA
| | - George A Beyer
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York, Downstate Medical Center, 450 Clarkson Avenue, Box 30, Brooklyn, NY, 11203, USA
| | - James C Messina
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York, Downstate Medical Center, 450 Clarkson Avenue, Box 30, Brooklyn, NY, 11203, USA
| | - Jeffrey E Mait
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York, Downstate Medical Center, 450 Clarkson Avenue, Box 30, Brooklyn, NY, 11203, USA
| | - Neil V Shah
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York, Downstate Medical Center, 450 Clarkson Avenue, Box 30, Brooklyn, NY, 11203, USA
| | - Bassel G Diebo
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York, Downstate Medical Center, 450 Clarkson Avenue, Box 30, Brooklyn, NY, 11203, USA.
| | - Carl B Paulino
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York, Downstate Medical Center, 450 Clarkson Avenue, Box 30, Brooklyn, NY, 11203, USA
| | - William P Urban
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York, Downstate Medical Center, 450 Clarkson Avenue, Box 30, Brooklyn, NY, 11203, USA
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Rosas S, Sabeh KG, Buller LT, Law TY, Kalandiak SP, Levy JC. Comorbidity effects on shoulder arthroplasty costs analysis of a nationwide private payer insurance data set. J Shoulder Elbow Surg 2017; 26:e216-e221. [PMID: 28139384 PMCID: PMC6386450 DOI: 10.1016/j.jse.2016.11.044] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 11/15/2016] [Accepted: 11/25/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the effect of common medical comorbidities on the reimbursements of different shoulder arthroplasty procedures. METHODS We conducted a retrospective query of a single private payer insurance claims database using PearlDiver (Warsaw, IN, USA) from 2010 to 2014. Our search included the Current Procedural Terminology codes and International Classification of Diseases, Ninth Revision codes for total shoulder arthroplasty (TSA), hemiarthroplasty, and reverse shoulder arthroplasty (RSA). Medical comorbidities were also searched for through International Classification of Diseases codes. The comorbidities selected for analysis were obesity, morbid obesity, hypertension, smoking, diabetes mellitus, hyperlipidemia, atrial fibrillation, chronic obstructive pulmonary disease, cirrhosis, depression, and chronic kidney disease (excluding end-stage renal disease). The reimbursement charges of the day of surgery, 90-day global period, and 90-day period excluding the initial surgical day of each comorbidity were analyzed and compared. Statistical analysis was conducted through analyses of variance or Kruskal-Wallis test. RESULTS Comorbidities did not have a significant effect on same-day reimbursements but instead caused a significant effect on the subsequent 89-day (interval) and 90-day reimbursements in the TSA and RSA cohorts. For TSA and RSA, the highest reimbursement costs during the 90-day period after surgery were seen with the diagnosis of hepatitis C, followed by atrial fibrillation and later chronic obstructive pulmonary disease. For hemiarthroplasty, the same was true in the following order: hepatitis C, cirrhosis, and atrial fibrillation. CONCLUSION Shoulder arthroplasty reimbursements are significantly affected by comorbidities at time intervals following the initial surgical day.
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Affiliation(s)
- Samuel Rosas
- Orthopedic Research Institute, Holy Cross Hospital, Fort Lauderdale, FL, USA,Department of Orthopedics and Rehabilitation, University of Miami, Miami, FL, USA
| | - Karim G. Sabeh
- Department of Orthopedics and Rehabilitation, University of Miami, Miami, FL, USA
| | - Leonard T. Buller
- Department of Orthopedics and Rehabilitation, University of Miami, Miami, FL, USA
| | - Tsun Yee Law
- Orthopedic Research Institute, Holy Cross Hospital, Fort Lauderdale, FL, USA
| | - Steven P. Kalandiak
- Department of Orthopedics and Rehabilitation, University of Miami, Miami, FL, USA
| | - Jonathan C. Levy
- Orthopedic Research Institute, Holy Cross Hospital, Fort Lauderdale, FL, USA,Reprint requests: Jonathan C. Levy, MD, Orthopedic Research Institute, Holy Cross Hospital, 5597 N Dixie Highway, Fort Lauderdale, FL 33334, USA. (J.C. Levy)
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