Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, TX, USA; Department of Orthopaedic Surgery and Rehabilitation, Texas Tech University Health Science Center, Paul Foster School of Medicine, El Paso, TX, USA.
Andrew Taylor Still University-School of Osteopathic Medicine in Arizona, Mesa, AZ, USA.
J Shoulder Elbow Surg. 2024 Mar;33(3):715-721. doi: 10.1016/j.jse.2023.07.012. Epub 2023 Oct 31.
The purpose of this study is to assess the trends in operative management of geriatric (≥65 years) proximal humerus fractures during a 6-year period (2015-2020) within an insurance claims database.
This retrospective database cohort study used data gathered from the 2015-2020 IBM Truven MarketScan Commercial and IBM Truven MarketScan Medicare Supplemental databases. The International Statistical Classification of Disease and Related Health Problems, Tenth Revision, data was correlated to the Current Procedural Terminology code for shoulder arthroplasty (proximal humeral prosthetic replacement: 23616, shoulder hemiarthroplasty [HA]: 23470, reverse total shoulder arthroplasty [rTSA]: 23472) or open reduction internal fixation (ORIF; open treatment of proximal humerus fracture with internal fixation: 23615, open treatment of proximal humerus fracture-dislocation with internal fixation: 23680). We investigated the number of proximal humerus fracture operative cases per year, percentage arthroplasty used per year, rTSA and HA per year, hospital cost information, as well as percentage arthroplasty per US geographic region.
A total of 8057 operative proximal humerus fractures cases were identified in 7697 patients aged >65 years, with 0.45% (360 of 8057) being bilateral. There was a 40.8% decrease in the rate of operative management of proximal humerus fractures between the first half (2015-2017, 1687.3 ± 146.6) and the second half of the study period (2018-2020, 998.3 ± 258.7). Arthroplasty accounted for 78.7% of all surgeries, 91% of those being rTSA. The total number of cases of rTSA and ORIF performed decreased per year (P = .01). The downward trend of percentage ORIF per year approached significance (P = .054). Arthroplasty was a more expensive option of payment for total case by almost $850.00 (P = .001). There was a larger percentage of arthroplasty performed in the Northeast and North Central US geographic regions.
Despite the rise of both the elderly population and related geriatric proximal humerus fractures, they were less operatively represented in this insurance claims database across the 6-year period. There may be a trend to use less ORIF when addressing these fractures. Although it incurred a higher in-hospital cost, arthroplasty was being performed at a higher percentage in the Northeast and North Central regions of the United States.
本研究旨在评估 6 年间（2015-2020 年）医疗保险理赔数据库中，老年（≥65 岁）肱骨近端骨折手术治疗的趋势。
本回顾性数据库队列研究使用了 2015-2020 年 IBM Truven MarketScan 商业和 IBM Truven MarketScan 补充医疗保险数据库的数据。国际疾病分类第十版与手术操作分类（ Shoulder Arthroplasty：23616；Shoulder Hemiarthroplasty：23470；Reverse Total Shoulder Arthroplasty：23472）或切开复位内固定（Open Reduction Internal Fixation：23615，Open Treatment of Proximal Humerus Fracture with Internal Fixation：23680）的相关数据进行了关联。我们调查了每年肱骨近端骨折手术病例数、每年使用的关节置换术百分比、每年行反式全肩关节置换术（rTSA）和人工半肩关节置换术（HA）的例数、医院费用信息，以及每个美国地理位置的关节置换术百分比。
在 7697 名年龄大于 65 岁的患者中，共确定了 8057 例肱骨近端骨折手术病例，其中 360 例（0.45%）为双侧骨折。肱骨近端骨折手术治疗率在研究期间的前半段（2015-2017 年，1687.3±146.6）和后半段（2018-2020 年，998.3±258.7）分别下降了 40.8%。关节置换术占所有手术的 78.7%，其中 91%为 rTSA。每年行 rTSA 和切开复位内固定术的病例数均减少（P=.01）。每年切开复位内固定术的比例呈下降趋势，接近显著水平（P=.054）。关节置换术的总费用比切开复位内固定术高近 850.00 美元（P=.001）。在美国东北和中北部地区，关节置换术的比例更高。
尽管老年人口和相关老年肱骨近端骨折的数量都有所增加，但在这 6 年的医疗保险理赔数据库中，手术治疗的比例却有所下降。在治疗这些骨折时，可能更倾向于选择切开复位内固定术。尽管关节置换术的住院费用更高，但在美国东北和中北部地区，关节置换术的比例更高。
