Proximal humerus fractures: national treatment trends with associated 30- and 90-day readmission rates.

BACKGROUND

The incidence of proximal humerus fractures is rising, with increasing use of reverse total shoulder arthroplasty (rTSA). This study analyzed treatment trends, readmission rates, and causes of readmission.

METHODS

The Nationwide Readmissions Database (NRD) was queried for admissions with a primary diagnosis of proximal humerus fracture in the U.S. (2016-2021) using ICD-10 codes. Patient demographics, comorbidities, facility characteristics, and 30-/90-day readmission rates were analyzed. Treatments included non-operative (Non-Op), hemiarthroplasty (HA), anatomic total shoulder arthroplasty (aTSA), rTSA, open reduction internal fixation (ORIF), and intramedullary nailing (IMN).

RESULTS

Among 218,425 admissions, rTSA use increased (20.27 % to 22.30 %), while ORIF decreased (20.77 % to 14.86 %). Non-Op had the highest readmission rates at 30- and 31-90 days (10.5 % and 8.9 %), even after adjusting for age/comorbidities. rTSA had the lowest readmission rates (5.9 % and 4.6 %), with instability being the most common cause.

CONCLUSION

There is a trend towards increased rTSA utilization for treating proximal humerus fractures. The readmission rate following rTSA was the lowest of all treatment modalities, including non-operative management.

LEVEL OF EVIDENCE: Level III Retrospective Cohort Comparison Using Large Database Prognosis Study.