A nationwide analysis of geriatric proximal humerus fractures: trends, outcomes, and cost
Background In the USA, proximal humerus fractures (PHF) are the third most common fracture among the elderly. Although most geriatric PHF are treated conservatively, surgical management remains an option. This retrospective study compares annual trends, patient outcomes, and hospital costs between o...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2023-10-01
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| Series: | Trauma Surgery & Acute Care Open |
| Online Access: | https://tsaco.bmj.com/content/8/1/e001055.full |
| _version_ | 1797371108773593088 |
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| author | Purvi P Patel Teresa Cheng Michael J Anstadt Richard P Gonzalez Kevin Galicia John Kubasiak |
| author_facet | Purvi P Patel Teresa Cheng Michael J Anstadt Richard P Gonzalez Kevin Galicia John Kubasiak |
| author_sort | Purvi P Patel |
| collection | DOAJ |
| description | Background In the USA, proximal humerus fractures (PHF) are the third most common fracture among the elderly. Although most geriatric PHF are treated conservatively, surgical management remains an option. This retrospective study compares annual trends, patient outcomes, and hospital costs between operatively and non-operatively managed geriatric PHF.Methods The Healthcare Cost and Utilization Project Nationwide Inpatient Sample was queried from 2012 to 2015. Geriatric patients with PHF were identified and those who underwent operative or non-operative management were compared in trends, outcomes and costs.Results In total, 137 810 patients met inclusion criteria, of which 51 795 (37.6%) underwent operative management. The operative cohort was younger (76.6 vs 80.9, p<0.001) with a greater proportion of females (81.8% vs 77.6%, p<0.001). The operative cohort demonstrated less frailty and lower Elixhauser Comorbidity Scores (both p<0.001). The operative cohort was also more likely to be discharged home (30.4% vs 13.9%, p<0.001). There was no significant linear trend in age-adjusted and sex-adjusted proportions of operative versus non-operative geriatric PHF (p=0.071), but a positive linear trend was statistically significant for total cost of operative geriatric PHF (p<0.001). Multivariable analyses demonstrated similar overall complication rates between cohorts (OR 0.95, 95% CI 0.89 to 1.00; p=0.06), although surgical intervention increased length of stay (LOS) by 0.15 days (95% CI 0.03 to 0.27; p<0.001) and median cost of hospitalization by US$10 684 (95% CI US$10 384 to US$10 984; p<0.001).Conclusions This study identifies a positive linear trend in total cost of operatively managed geriatric PHF from 2012 to 2015. Operative management of geriatric PHF is associated with a similar overall complication rate and greater likelihood of being discharged home. Although non-operative management is associated with decreased LOS and hospital expenses, providers should consider surgical PHF treatment options when available and appropriate in the context of patient-focused outcomes, particularly long-term disposition after intervention.Level of Evidence This level IV retrospective study identifies. |
| first_indexed | 2024-03-08T18:15:02Z |
| format | Article |
| id | doaj.art-e1cd2b38d9ef464eb3c4cfa7fe0cc01f |
| institution | Directory Open Access Journal |
| issn | 2397-5776 |
| language | English |
| last_indexed | 2024-03-08T18:15:02Z |
| publishDate | 2023-10-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Trauma Surgery & Acute Care Open |
| spelling | doaj.art-e1cd2b38d9ef464eb3c4cfa7fe0cc01f2023-12-31T15:55:07ZengBMJ Publishing GroupTrauma Surgery & Acute Care Open2397-57762023-10-018110.1136/tsaco-2022-001055A nationwide analysis of geriatric proximal humerus fractures: trends, outcomes, and costPurvi P Patel0Teresa Cheng1Michael J Anstadt2Richard P Gonzalez3Kevin Galicia4John Kubasiak5Department of Surgery, Loyola University Medical Center, Maywood, Illinois, USADepartment of Surgery, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, USADepartment of Surgery, Loyola University Medical Center, Maywood, Illinois, USADepartment of Surgery, Loyola University Medical Center, Maywood, Illinois, USADepartment of Surgery, Loyola University Medical Center, Maywood, Illinois, USADepartment of Surgery, Loyola University Medical Center, Maywood, Illinois, USABackground In the USA, proximal humerus fractures (PHF) are the third most common fracture among the elderly. Although most geriatric PHF are treated conservatively, surgical management remains an option. This retrospective study compares annual trends, patient outcomes, and hospital costs between operatively and non-operatively managed geriatric PHF.Methods The Healthcare Cost and Utilization Project Nationwide Inpatient Sample was queried from 2012 to 2015. Geriatric patients with PHF were identified and those who underwent operative or non-operative management were compared in trends, outcomes and costs.Results In total, 137 810 patients met inclusion criteria, of which 51 795 (37.6%) underwent operative management. The operative cohort was younger (76.6 vs 80.9, p<0.001) with a greater proportion of females (81.8% vs 77.6%, p<0.001). The operative cohort demonstrated less frailty and lower Elixhauser Comorbidity Scores (both p<0.001). The operative cohort was also more likely to be discharged home (30.4% vs 13.9%, p<0.001). There was no significant linear trend in age-adjusted and sex-adjusted proportions of operative versus non-operative geriatric PHF (p=0.071), but a positive linear trend was statistically significant for total cost of operative geriatric PHF (p<0.001). Multivariable analyses demonstrated similar overall complication rates between cohorts (OR 0.95, 95% CI 0.89 to 1.00; p=0.06), although surgical intervention increased length of stay (LOS) by 0.15 days (95% CI 0.03 to 0.27; p<0.001) and median cost of hospitalization by US$10 684 (95% CI US$10 384 to US$10 984; p<0.001).Conclusions This study identifies a positive linear trend in total cost of operatively managed geriatric PHF from 2012 to 2015. Operative management of geriatric PHF is associated with a similar overall complication rate and greater likelihood of being discharged home. Although non-operative management is associated with decreased LOS and hospital expenses, providers should consider surgical PHF treatment options when available and appropriate in the context of patient-focused outcomes, particularly long-term disposition after intervention.Level of Evidence This level IV retrospective study identifies.https://tsaco.bmj.com/content/8/1/e001055.full |
| spellingShingle | Purvi P Patel Teresa Cheng Michael J Anstadt Richard P Gonzalez Kevin Galicia John Kubasiak A nationwide analysis of geriatric proximal humerus fractures: trends, outcomes, and cost Trauma Surgery & Acute Care Open |
| title | A nationwide analysis of geriatric proximal humerus fractures: trends, outcomes, and cost |
| title_full | A nationwide analysis of geriatric proximal humerus fractures: trends, outcomes, and cost |
| title_fullStr | A nationwide analysis of geriatric proximal humerus fractures: trends, outcomes, and cost |
| title_full_unstemmed | A nationwide analysis of geriatric proximal humerus fractures: trends, outcomes, and cost |
| title_short | A nationwide analysis of geriatric proximal humerus fractures: trends, outcomes, and cost |
| title_sort | nationwide analysis of geriatric proximal humerus fractures trends outcomes and cost |
| url | https://tsaco.bmj.com/content/8/1/e001055.full |
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