Treatment choice affects inpatient adverse events and mortality in older aged inpatients with an isolated fracture of the proximal humerus.
Treatment choice affects inpatient adverse events and mortality in older aged inpatients with an isolated fracture of the proximal humerus.
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DOI：
10.1016/j.jse.2013.09.006
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发表时间：
2014-06
影响因子：
3
通讯作者：
Ring, David C.
中科院分区：
文献类型：
--
作者：
Neuhaus, Valentin;Bot, Arjan G. J.;Swellengrebel, Christiaan H. J.;Jain, Nitin B.;Warner, Jon J. P.;Ring, David C.
关键词：
本研究检验了零假设，即在因肱骨近端孤立性骨折（无其他损伤或骨折）而入住美国医院的65岁及以上患者中，手术（固定或关节成形术）和非手术治疗在住院不良事件、住院死亡率和考虑合并症的出院至长期护理机构的比率方面无差异。使用一个大型国家数据库，该数据库代表了2003年至2007年期间因孤立性肱骨近端骨折而在美国医院住院的约132，005例65岁及以上患者。61%的患者没有手术，22%的患者接受切开复位内固定（ORIF）治疗，17%的患者接受关节成形术治疗。住院不良事件的总体风险为21%，与非手术治疗相比，关节成形术的风险高出4.4倍，ORIF的风险高出2.7倍。住院死亡的风险总体为1.8%，ORIF治疗的风险是非手术治疗的2.8倍。与非手术治疗的患者相比，手术治疗的患者不太可能出院到长期机构。尽管倾向于对最虚弱的患者（未出院回家的患者）进行非手术治疗，但手术治疗（特别是切开复位和内固定）是因肱骨近端骨折住院的老年患者住院不良事件和死亡率的独立风险因素，可能应该更明智地提供。III级，回顾性队列研究，治疗研究。
This study tests the null hypothesis that, among patients aged 65 and older admitted to a United States hospital with an isolated fracture of the proximal humerus (no other injuries or fractures), there are no differences between operative (fixation or arthroplasty) and nonoperative treatments with respect to inpatient adverse events, inpatient mortality, and discharge to a long-term care facility rates accounting for comorbidities. Using a large national database representing an estimated 132,005 patients aged 65 and older admitted to a US hospital with an isolated proximal humerus fracture between 2003 and 2007. Sixty-one percent did not have surgery, 22% were treated with open reduction and internal fixation (ORIF), and 17% were treated with arthroplasty. The risk of an in hospital adverse event was 21% overall and was 4.4 times greater with arthroplasty and 2.7 times greater with ORIF compared to nonoperative treatment. The risk of in hospital death was 1.8% overall and was 2.8 times greater with ORIF compared to nonoperative treatment. Patients treated operatively were less likely to be discharged to a long-term facility compared to patients treated nonoperatively. In spite of a tendency to treat the most infirm patients (those that are not discharged to home) nonoperatively, operative treatment (open reduction and internal fixation in particular) is an independent risk factor for inpatient adverse events and mortality in older-aged patients admitted to the hospital with an isolated fracture of the proximal humerus and should perhaps be offered more judiciously. Level III, Retrospective Cohort Study, Treatment Study.
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影响因子：
120.7
作者：
LEMESHOW, S;TERES, D;RAPOPORT, J
通讯作者：
RAPOPORT, J
DOI：
10.1111/j.1532-5415.2008.02141.x
发表时间：
2009-03-01
影响因子：
6.3
作者：
Batsis, John A.;Huddleston, Jeanne M.;McMahon, M. Molly
通讯作者：
McMahon, M. Molly
影响因子：
2.7
作者：
Roederer, Goetz;Erhardt, Johannes;Gebhard, Florian
通讯作者：
Gebhard, Florian
影响因子：
3
作者：
Sperling, JW;Cofield, RH;Rowland, CM
通讯作者：
Rowland, CM
影响因子：
3
作者：
Majed, Addie;Macleod, Iain;Emery, Roger J. H.
通讯作者：
Emery, Roger J. H.