Fisher Nina D, Driesman Adam, Saleh Hesham, Egol Kenneth A, Konda Sanjit R
Orthopedic Surgery, New York University (NYU) Langone Health, New York City, USA.
Orthopedic Surgery, Jamaica Hospital Medical Center, New York City, USA.
Cureus. 2022 Jul 7;14(7):e26631. doi: 10.7759/cureus.26631. eCollection 2022 Jul.
The ability to predict long-term outcomes following surgical fixation of proximal humerus fractures would help identify patients at risk of poor functional outcomes. The purpose of this study was to develop a simple score based on preoperative data that can accurately predict functional outcomes for patients following operative management of proximal humerus fractures.
Over a 12-year period, all proximal humerus fractures surgically treated with a locked proximal humerus plate at a single institution were enrolled in a prospective database. Inclusion criteria in this analysis were any patient with a minimum of a one-year functional outcome score. Patients were assigned to the poor outcome cohort if their Disabilities of the Arm, Shoulder, and Hand (DASH) score at that time point was greater than 10 points above the mean DASH score. Logistic regression was used to build a predictive formula for cohort membership using p < 0.15 and an area under the receiver operator characteristic curve (AUROC) value was calculated to define the overall predictive capacity.
A total of 165 patients with an average age of 60.91±13.5 years met the inclusion criteria, with 47 (28.5%) patients assigned to the poor outcome group and 118 (71.5%) patients assigned to the good outcome group. Older age (p = 0.088), BMI (p = 0.019), age-adjusted CCI (p = 0.001), non-Caucasian race (p = 0.017), no college degree (p < 0.0005), unemployed (p < 0.0005), and worker's compensation case (p = 0.002) were found to be significant predictors of poorer outcome and were used to create a final formula through logistic regression which predicted the probability of a poor outcome (Nagelkerke R Square = 0.403; Hosmer and Lemeshow = 0.902; AUROC = 0.839 [CI: 0.762-0.917]). Once each patient was assigned a score, cutoff values were defined that divided the cohort into three groups. High-risk patients had a score above 50%, and 19 (73.1%) of these patients had a poor outcome.
The POSY score is a tool that can predict the functional outcome at one year or greater following surgical intervention for a proximal humerus fracture. Patients who score above 50% are considered at high risk for a poor functional outcome. In the era of value-based care, the POSY score may be used to direct resource utilization while improving outcomes.
预测肱骨近端骨折手术固定后的长期预后能力，将有助于识别功能预后不良风险的患者。本研究的目的是基于术前数据开发一种简单评分系统，能够准确预测肱骨近端骨折手术治疗患者的功能预后。
在12年期间，一家机构所有采用锁定肱骨近端钢板手术治疗的肱骨近端骨折患者均纳入前瞻性数据库。本分析的纳入标准为功能预后评分至少1年的任何患者。如果患者在该时间点的手臂、肩部和手部功能障碍（DASH）评分高于平均DASH评分10分以上，则被分配到预后不良队列。采用逻辑回归建立队列成员的预测公式，使用p<0.15，并计算受试者工作特征曲线下面积（AUROC）值来定义总体预测能力。
共有165例平均年龄为60.91±13.5岁的患者符合纳入标准，其中47例（28.5%）患者被分配到预后不良组，118例（71.5%）患者被分配到预后良好组。年龄较大（p = 0.088）、体重指数（p = 0.019）、年龄校正的Charlson合并症指数（p = 0.001）、非白种人（p = 0.017）、无大学学历（p < 0.0005）、失业（p < 0.0005）和工伤赔偿病例（p = 0.002）被发现是预后较差的显著预测因素，并通过逻辑回归用于创建最终公式，该公式预测了预后不良的概率（Nagelkerke R平方 = 0.403；Hosmer和Lemeshow = 0.902；AUROC = 0.839 [CI：0.762 - 0.917]）。一旦为每位患者分配一个分数，定义了将队列分为三组的临界值。高危患者的分数高于50%，其中19例（73.1%）患者预后不良。
POSY评分是一种可预测肱骨近端骨折手术干预后1年或更长时间功能预后的工具。评分高于50%的患者被认为功能预后不良风险高。在基于价值的医疗时代，POSY评分可用于指导资源利用，同时改善预后。
