Blood transfusion and surgical treatment increase mortality in patient with proximal humeral fractures

Abstract

Introduction: Proximal humeral fractures (PHFs) often occur in elderly patients with osteoporosis and associated comorbidities. These patients constitute a special risk group. This study aimed to identify associations between comorbidities, treatment type, and mortality risk.

Patients and methods: We conducted a retrospective chart review of a cohort of 350 patients with a diagnosis of PHF and a mean follow-up of 4.5 years. We analysed the 19 prefracture comorbidities included in the Charlson Comorbidity Index (CCI), haemoglobin (Hb) levels, blood transfusion needs, and treatment administered (surgery versus conservative). The nonparametric Kaplan-Meier method and Cox proportional hazards model were used to estimate the mortality risk.

Results: Over a 4.5-year average follow-up of 350 patients, primarily elderly females, with proximal humerus fractures, several factors were associated with increased mortality. The Charlson Comorbidity Index (CCI) was a significant predictor, with patients having a CCI > 5 facing higher mortality risks, especially if they underwent surgery. Additionally, osteosynthesis was linked to a lower mortality rate compared to arthroplasty. Age, dementia, medical complications, and postfracture Hb level also influenced mortality rates. CONCLUSIóN: These findings emphasize the importance of considering comorbidities, specifically the Charlson Comorbidity Index (CCI), in determining patient outcomes, especially amongst elderly patients with proximal humerus fractures. Factors like age, dementia, and postfracture Hb level also play a crucial role in influencing mortality rates.

Trial registration: The study received written approval from the regional Ethics Committee for Clinical Research (code 2016/125).

Keywords: Blood transfusion; Charlson comorbidity index; Mortality; Proximal humeral fracture; Survival analysis.