Mester Bastian, Maali Raed, Meyer Heinz-Lothar, Polan Christina, Herbstreit Stephanie, Herten Monika, Becker Lars, Dudda Marcel, Burggraf Manuel
Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, Essen, Germany.
University Health Orthopaedics, University of Missouri, Kansas City, MO, USA.
Geriatr Orthop Surg Rehabil. 2025 Mar 18;16:21514593251325365. doi: 10.1177/21514593251325365. eCollection 2025.
While epidemiology and treatment strategies of proximal humerus fractures have been well studied, post-hospital care is poorly analysed. Corresponding data is available in the context of hip fractures, but the evidence regarding proximal humerus fractures is weak. Aim of this study is to identify risk factors for institutionalisation required after discharge into inpatient aftercare for elderly patients treated for proximal humerus fractures.
For this retrospective single-centre investigation, n = 295 patients (age 70 (58,79) years, 63.7% female) admitted to hospital from home due to proximal humerus fractures were included and divided into two study groups: Patients being discharged home () vs being discharged into aftercare (). Differences regarding demographic and clinical data were analysed. Odds ratios (OR) of influencing factors (adjusted for age) were calculated by logistic regression analysis.
Increased age notably increased the likelihood for discharge of patients into 'Aftercare' (OR 1.09 [1.06;1.12] per year of life). Age-independent indicators for 'Aftercare' were higher ASA score (OR 2.16 per ASA point [1.37;3.49]; < .001), anterior surgical approach (OR 6.05 [1.93,27.1]; < .006), duration of surgery (OR 1.01 per min [1.00,1.02]; < .012), non-surgical complications (OR 3.82 [1.60,9.49]; < .003), length of stay (OR 1.12 per day [1.04,1.22]; < .005), ICU stay (OR 3.15 [1.71,6.00]; < .001) and reversely surgery (OR 0.39 [0.19,0.80]; < .010).
Increased Age and higher ASA score notably increase the likelihood for post-hospital discharge to an inpatient aftercare facility. Available literature in the context of hip fractures is confirmed. The results of this study may assist in identifying patients at risk and may serve as a stepstone in establishing a scoring system for elderly patients with proximal humerus fractures.
虽然肱骨近端骨折的流行病学和治疗策略已得到充分研究，但出院后的护理情况分析不足。髋部骨折方面有相应数据，但关于肱骨近端骨折的证据薄弱。本研究的目的是确定肱骨近端骨折老年患者出院后转入住院康复机构所需的危险因素。
在这项回顾性单中心研究中，纳入了n = 295例因肱骨近端骨折从家中入院的患者（年龄70（58,79）岁，63.7%为女性），并将其分为两个研究组：出院回家的患者（）与出院后接受康复护理的患者（）。分析了人口统计学和临床数据的差异。通过逻辑回归分析计算影响因素的比值比（OR）（按年龄调整）。
年龄增加显著增加了患者出院后转入“康复护理”的可能性（每年生命的OR为1.09 [1.06;1.12]）。与年龄无关的“康复护理”指标包括较高的ASA评分（每增加一个ASA分值的OR为2.16 [1.37;3.49]；P <.001）、前路手术入路（OR为6.05 [1.93,27.1]；P <.006）、手术持续时间（每分钟的OR为1.01 [1.00,1.02]；P <.012）、非手术并发症（OR为3.82 [1.60,9.49]；P <.003）、住院时间（每天的OR为1.12 [1.04,1.22]；P <.005）、入住重症监护病房（OR为3.15 [1.71,6.00]；P <.001），以及相反的手术（OR为0.39 [0.19,0.80]；P <.010）。
年龄增加和较高的ASA评分显著增加了出院后转入住院康复机构的可能性。髋部骨折方面的现有文献得到了证实。本研究结果可能有助于识别有风险的患者，并可作为建立肱骨近端骨折老年患者评分系统的垫脚石。
