Complutense University of Madrid, Madrid, Spain.
Department of Orthopaedic Surgery, Cosaga Hospital, Complexo Hospitalario Universitario de Ourense, Ourense, Spain.
Musculoskelet Surg. 2021 Aug;105(2):167-172. doi: 10.1007/s12306-020-00642-2. Epub 2020 Feb 1.
The purpose of this study was to evaluate the relevance of a commonly used morbidity prognostic tool, the Charlson comorbidity index (CCI), in determining the survival rate of patients with isolated proximal humeral fractures (PHFs) and to determine the impact of surgical treatment according to previous comorbidities (measured with CCI).
All patients who were treated for a single PHF in our institution for 29 consecutive months were included in this retrospective study, with a minimum follow-up of 24 months (mean 52.8 months). Two groups were established according to the type of treatment received (surgical versus non-surgical). Preinjury comorbidities were identified, and the age-adapted CCI was calculated. All complications and mortality rates were prospectively recorded over the complete follow-up period.
Patients with elevated preinjury comorbidities (CCI > 5) demonstrated a significant increase in mortality (HR = 4.64) compared to those with CCI ≤ 5. In addition, patients with high comorbidities (CCI > 5) who underwent surgical treatment demonstrated a statistically significant increase in mortality (HR = 6.92) compared to patients with similarly high comorbidities (CCI > 5) who underwent non-surgical treatment.
Patients with high preinjury comorbidities (CCI > 5) experienced an increased mortality risk if they underwent surgical treatment for isolated PHFs. The use of a morbidity prognostic tool, such as the CCI, can help predict the outcome (particularly mortality) in these patients and may aid in making decisions in terms of operative versus non-operative treatment to minimize patient mortality.
Level III; Retrospective Comparative Study; Treatment Study.
本研究旨在评估一种常用的疾病预后工具——Charlson 合并症指数（CCI），在确定单纯肱骨近端骨折（PHF）患者生存率方面的相关性，并根据既往合并症（CCI 测量）确定手术治疗的影响。
本回顾性研究纳入了 29 个月内我院收治的所有接受单一 PHF 治疗的患者，随访时间至少为 24 个月（平均 52.8 个月）。根据所接受的治疗类型（手术与非手术）将患者分为两组。确定受伤前合并症，并计算年龄校正的 CCI。在整个随访期间，前瞻性记录所有并发症和死亡率。
与 CCI≤5 的患者相比，CCI 升高（CCI>5）的患者死亡风险显著增加（HR=4.64）。此外，CCI 升高（CCI>5）且接受手术治疗的患者死亡率显著高于 CCI 升高（CCI>5）且接受非手术治疗的患者（HR=6.92）。
对于接受手术治疗的单纯 PHF 患者，CCI 升高（CCI>5）的患者具有更高的死亡风险。使用疾病预后工具（如 CCI）可帮助预测这些患者的预后（尤其是死亡率），并有助于在手术与非手术治疗之间做出决策，以最大程度地降低患者死亡率。
III 级；回顾性比较研究；治疗研究。
