Orthopaedic Session I
AB121. SOH26AB_0230. Mortality in patients over 65 years with proximal humerus fractures: a systematic review of 414,379 shoulders with meta-analysis
Liam O’Dwyer1, Muiris Rowsome2, Martin Davey3, Johan van der Stok4, Aoife Leahy5, John Tristan Cassidy4
1Department of Surgery, University Hospital Limerick, Limerick, Ireland;
2Faculty of Education and Health Services, School of Medicine, University of Limerick, Limerick, Ireland;
3Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland;
4Department of Orthopaedics, University Hospital Limerick, Limerick, Ireland;
5Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
Background: Proximal humerus fractures (PHFs) often lead to significant morbidity for patients and are associated with an increased risk of mortality. The aim of this study was to assess the mortality rate in patients over 65 years old with PHFs. Mortality risk was assessed for 30-day/in-hospital, 1-year, and 5-year follow-up and was compared based on treatment type.
Methods: A systematic review and meta-analysis was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were included if they reported mortality rates at 30-day/in-hospital, 1-year, or 5-year in patients ≥65 years with PHFs. Data were analysed using a random-effects model. Subgroup analysis was performed by treatment type (operative vs. non-operative).
Results: Seventeen studies, including 414,379 shoulders (82% female) with a mean age of 78.8±2.5 years, reported 1-year mortality. Meta-analysis yielded a pooled 1-year mortality rate of 10% [95% confidence interval (CI): 8.97–11.20%]. Mortality was significantly lower in the operative group (7.92%; 95% CI: 6.98–8.86%) compared to the non-operative group (10.80%; 95% CI: 9.44–12.17%), with a difference of −2.89% (95% CI: −4.54% to −1.23%). Pooled 30-day/in-hospital mortality was 1.74% (95% CI: 1.39–2.10%), and 5-year mortality was 36.10% (95% CI: 34.50–37.70%).
Conclusions: For patients ≥65 years, PHFs are associated with high rates of mortality in the short-to-medium term: 10% at 1-year, and 36% at 5-year follow-up. Lower rates of mortality were found for the operatively managed PHFs, but causality cannot be inferred based on this meta-analysis. Nonetheless, these high mortality rates in patient ≥65 years firmly support PHFs being a fragility fracture, and the treatment of PHFs should therefore be prioritised in a similar manner as hip fragility fractures.
Keywords: Shoulder; fragility; humerus; mortality; fracture
Acknowledgments
None.
Funding: None.
Conflicts of Interest: The authors have no conflicts of interest to declare.
Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.
doi: 10.21037/map-26-ab121
Cite this abstract as: O’Dwyer L, Rowsome M, Davey M, van der Stok J, Leahy A, Cassidy JT. AB121. SOH26AB_0230. Mortality in patients over 65 years with proximal humerus fractures: a systematic review of 414,379 shoulders with meta-analysis. Mesentery Peritoneum 2026;10:AB121.
