Male Sex Is Associated with Higher Mortality and Increased Risk for Complications after Surgical Treatment of Proximal Humeral Fractures
Open Access
- 5 June 2021
- journal article
- research article
- Published by MDPI AG in Journal of Clinical Medicine
- Vol. 10 (11), 2500
- https://doi.org/10.3390/jcm10112500
Abstract
Aims: The best surgical treatment of multi-fragmentary proximal humeral fractures in the elderly is a highly controversial topic. The aim of this study is to assess for sex-related differences regarding mortality and complications after reverse total shoulder arthroplasty (RTSA) and locking plate fixation (LPF). Patients and Methods: All patients from the largest German healthcare insurance (26.5 million policy holders) above the age of 65 years that were treated with LPF or RTSA after a multi-fragmentary proximal humerus fracture between January 2010 and September 2018 were included. Multivariable Cox regression models were used to assess the association of sex with overall survival, major adverse events and surgical complications. Results: A total of 8264 (15%) men and 45,707 (85%) women were followed up for a median time of 52 months. After 8 years, male patients showed significantly higher rates for death (65.8%; 95% CI 63.9–67.5% vs. 51.1%; 95% CI 50.3–51.9%; p < 0.001) and major adverse events (75.5%; 95% CI 73.8–77.1% vs. 61.7%; 95% CI 60.9–62.5%; p < 0.001). With regard to surgical complications, after adjustment of patient risk profiles, there were no differences between females and males after LPF (p > 0.05), whereas men showed a significantly increased risk after RTSA (HR 1.86; 95% CI 1.56–2.22; p < 0.001) with more revision surgeries performed (HR 1.76, 95% CI 1.46–2.12; p < 0.001) compared to women. Conclusion: The male sex is an independent risk factor for death and major adverse events after both LPF and RTSA. An increased risk for surgical complications after RTSA suggests that male patients benefit more from LPF. Sex should be considered before making treatment decisions.This publication has 57 references indexed in Scilit:
- The complexity of proximal humeral fractures is age and gender specificJournal of Orthopaedic Science, 2013
- Long term functional outcome following reverse shoulder arthroplasty in the elderlyOrthopaedics & Traumatology: Surgery & Research, 2011
- Male–female differences in the association between incident hip fracture and proximal femoral strength: A finite element analysis studyBone, 2011
- A systematic review of locking plate fixation of proximal humerus fracturesInjury, 2011
- Updating and Validating the Charlson Comorbidity Index and Score for Risk Adjustment in Hospital Discharge Abstracts Using Data From 6 CountriesAmerican Journal of Epidemiology, 2011
- Age- and sex-related changes of humeral head microarchitecture: Histomorphometric analysis of 60 human specimensJournal of Orthopaedic Research, 2009
- Fractures as predictors of excess mortality in the aged—A population-based study with a 12-year follow-upEuropean Journal of Epidemiology, 2008
- The bone quality framework: Determinants of bone strength and their interrelationships, and implications for osteoporosis managementClinical Therapeutics, 2005
- Increased mortality after fracture of the surgical neck of the humerusA case-control study of 253 patients with a 12-year follow-upActa Orthopaedica, 2003
- A new method of classifying prognostic comorbidity in longitudinal studies: Development and validationJournal of Chronic Diseases, 1987