$Analysis of predictors of mortality after surgical and non-surgical management in proximal humerus fractures$
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Analysis of predictors of mortality after surgical and non-surgical management in proximal humerus fractures

Abstract Background Proximal humerus fractures are one of the main osteoporotic fractures. Choosing between conservative or surgical treatment is a controversial topic in the literature, as is the functional impact. The main aim of our study was to analyse whether patient comorbidities should influe...

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Autores principales:	Alejandro Garcia-Reza, Diego Matias Dominguez-Prado, Constantino Iglesias-Nuñez, Lucia Alvarez-Alvarez, Beatriz Hernandez-Gonzalez, Patricia Balvis-Balvis, Daniel Fernandez-Fernandez, Manuel Castro-Menendez
Formato:	article
Lenguaje:	EN
Publicado:	SpringerOpen 2021
Materias:	Humerus Fractures Mortality Comorbidities Charlson comorbidity index Orthopedic surgery RD701-811
Acceso en línea:	https://doaj.org/article/32443d81bff046dc99f613519dae9fa3
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spelling	oai:doaj.org-article:32443d81bff046dc99f613519dae9fa32021-11-08T11:05:18ZAnalysis of predictors of mortality after surgical and non-surgical management in proximal humerus fractures10.1186/s10195-021-00606-71590-99211590-9999https://doaj.org/article/32443d81bff046dc99f613519dae9fa32021-11-01T00:00:00Zhttps://doi.org/10.1186/s10195-021-00606-7https://doaj.org/toc/1590-9921https://doaj.org/toc/1590-9999Abstract Background Proximal humerus fractures are one of the main osteoporotic fractures. Choosing between conservative or surgical treatment is a controversial topic in the literature, as is the functional impact. The main aim of our study was to analyse whether patient comorbidities should influence the final therapeutic decision for these fractures. Material and methods We collected data from 638 patients with proximal humerus fractures. The main variable collected was exitus. We also collected the following data: age, gender, type of fracture, laterality, type of treatment, production mechanism, comorbidities and the Charlson comorbidity index (CCI) for each patient. The therapeutic indication used the criteria established by the Upper Limb Unit in our centre. We performed chi-square tests, Fischer’s exact tests and Student’s t-tests to compare the variables. We used the Kaplan–Meier method to analyse both the overall and disease-specific survival rates. We employed the Cox regression model to analyse factors associated with mortality. Results Patients with a CCI greater than 5 showed greater mortality (HR = 3.83; p < 0.001) than those with a CCI lower than 5. Within the patients who underwent surgery, those with a CCI higher than 5 had an increased mortality rate (HR = 22.6; p < 0.001) compared with those with a CCI lower than 5. Within the patients who received conservative treatment, those with a CCI over 5 showed greater mortality (HR = 3.64; p < 0.001) than those with a CCI under 5. Conclusions Patients with proximal humerus fractures and associated comorbidities (CCI > 5) presented higher mortality than healthier patients. This mortality risk was greater in patients with comorbidities if surgical treatment was indicated rather than conservative treatment. Patient’s comorbidities should be a fundamental parameter when planning the therapeutic strategy. Level of evidence Level 3.Alejandro Garcia-RezaDiego Matias Dominguez-PradoConstantino Iglesias-NuñezLucia Alvarez-AlvarezBeatriz Hernandez-GonzalezPatricia Balvis-BalvisDaniel Fernandez-FernandezManuel Castro-MenendezSpringerOpenarticleHumerusFracturesMortalityComorbiditiesCharlson comorbidity indexOrthopedic surgeryRD701-811ENJournal of Orthopaedics and Traumatology, Vol 22, Iss 1, Pp 1-9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Humerus Fractures Mortality Comorbidities Charlson comorbidity index Orthopedic surgery RD701-811
spellingShingle	Humerus Fractures Mortality Comorbidities Charlson comorbidity index Orthopedic surgery RD701-811 Alejandro Garcia-Reza Diego Matias Dominguez-Prado Constantino Iglesias-Nuñez Lucia Alvarez-Alvarez Beatriz Hernandez-Gonzalez Patricia Balvis-Balvis Daniel Fernandez-Fernandez Manuel Castro-Menendez Analysis of predictors of mortality after surgical and non-surgical management in proximal humerus fractures
description	Abstract Background Proximal humerus fractures are one of the main osteoporotic fractures. Choosing between conservative or surgical treatment is a controversial topic in the literature, as is the functional impact. The main aim of our study was to analyse whether patient comorbidities should influence the final therapeutic decision for these fractures. Material and methods We collected data from 638 patients with proximal humerus fractures. The main variable collected was exitus. We also collected the following data: age, gender, type of fracture, laterality, type of treatment, production mechanism, comorbidities and the Charlson comorbidity index (CCI) for each patient. The therapeutic indication used the criteria established by the Upper Limb Unit in our centre. We performed chi-square tests, Fischer’s exact tests and Student’s t-tests to compare the variables. We used the Kaplan–Meier method to analyse both the overall and disease-specific survival rates. We employed the Cox regression model to analyse factors associated with mortality. Results Patients with a CCI greater than 5 showed greater mortality (HR = 3.83; p < 0.001) than those with a CCI lower than 5. Within the patients who underwent surgery, those with a CCI higher than 5 had an increased mortality rate (HR = 22.6; p < 0.001) compared with those with a CCI lower than 5. Within the patients who received conservative treatment, those with a CCI over 5 showed greater mortality (HR = 3.64; p < 0.001) than those with a CCI under 5. Conclusions Patients with proximal humerus fractures and associated comorbidities (CCI > 5) presented higher mortality than healthier patients. This mortality risk was greater in patients with comorbidities if surgical treatment was indicated rather than conservative treatment. Patient’s comorbidities should be a fundamental parameter when planning the therapeutic strategy. Level of evidence Level 3.
format	article
author	Alejandro Garcia-Reza Diego Matias Dominguez-Prado Constantino Iglesias-Nuñez Lucia Alvarez-Alvarez Beatriz Hernandez-Gonzalez Patricia Balvis-Balvis Daniel Fernandez-Fernandez Manuel Castro-Menendez
author_facet	Alejandro Garcia-Reza Diego Matias Dominguez-Prado Constantino Iglesias-Nuñez Lucia Alvarez-Alvarez Beatriz Hernandez-Gonzalez Patricia Balvis-Balvis Daniel Fernandez-Fernandez Manuel Castro-Menendez
author_sort	Alejandro Garcia-Reza
title	Analysis of predictors of mortality after surgical and non-surgical management in proximal humerus fractures
title_short	Analysis of predictors of mortality after surgical and non-surgical management in proximal humerus fractures
title_full	Analysis of predictors of mortality after surgical and non-surgical management in proximal humerus fractures
title_fullStr	Analysis of predictors of mortality after surgical and non-surgical management in proximal humerus fractures
title_full_unstemmed	Analysis of predictors of mortality after surgical and non-surgical management in proximal humerus fractures
title_sort	analysis of predictors of mortality after surgical and non-surgical management in proximal humerus fractures
publisher	SpringerOpen
publishDate	2021
url	https://doaj.org/article/32443d81bff046dc99f613519dae9fa3
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Analysis of predictors of mortality after surgical and non-surgical management in proximal humerus fractures

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