Biological sex impacts perioperative complications after reverse shoulder arthroplasty for proximal humeral fracture

Ezuma, Chimere O.; Kosber, Rashed; Kovacevic, David

doi:10.1016/j.jseint.2020.12.005

Cited by 7 publications

(3 citation statements)

References 42 publications

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“… 34 In addition, Ezuma et al documented men were 2.38 times more likely to have perioperative and postoperative RSA complications and 10.59 times more likely to return to the operating room for an unplanned reoperation than women even though significantly more women compared with men older than 65 years underwent RSA for proximal humerus fractures. 11 Male patients and patients with multiple comorbidities in the setting of a complex proximal humerus fracture may be at a higher risk of complications with RSA. In concert with previous literature, the present study reported men in the 65 years and older cohort to be significantly less likely to receive RSA for a proximal humerus fracture than similarly aged women.…”

Section: Discussionmentioning

confidence: 99%

How age and gender influence proximal humerus fracture management in patients older than fifty years

Patel¹,

Wilder²,

Ofa³

et al. 2022

JSES International

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Section: Discussionmentioning

confidence: 99%

How age and gender influence proximal humerus fracture management in patients older than fifty years

Patel¹,

Wilder²,

Ofa³

et al. 2022

JSES International

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“…This finding echoes that of Ezuma et al, who used the National Surgical Quality Improvement Program database to compare complication rates after RTSA for PHF and found that males had a 2.4-fold risk of developing any 30-day complication and a 10-fold risk of 30-day reoperation. 21 Male sex has also been shown to be an independent risk factor for instability and dislocation, 22 re-admission, 23 and reoperation after RTSA. 24 Between 2000 and 2017, the proportion of patients treated with hemiarthroplasty dropped from 31% to 12%.…”

Section: Discussionmentioning

confidence: 99%

Short-Term Outcomes and Long-Term Implant Survival After Inpatient Surgical Management of Geriatric Proximal Humerus Fractures

Shi,

Upfill-Brown,

et al. 2023

Journal of Shoulder and Elbow Arthroplasty

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Introduction The most common surgical options for geriatric proximal humerus fractures are open reduction and internal fixation (ORIF), hemiarthroplasty (HA), and reverse total shoulder arthroplasty. We used a longitudinal inpatient discharge database to determine the cumulative incidence of conversion to arthroplasty after ORIF of geriatric proximal humerus fractures. The rates of short-term complications and all-cause reoperation were also compared. Patients and Methods All patients 65 or older who sustained a proximal humerus fracture and underwent either ORIF, HA, or shoulder arthroplasty (SA) as an inpatient from 2000 through 2017 were identified. Survival analysis was performed with ORIF conversion to arthroplasty and all-cause reoperation as the endpoints of interest. Rates of 30-day readmission and short-term complications were compared. Trends in procedure choice and outcomes over the study period were analyzed. Results A total of 27 102 geriatric patients that underwent inpatient surgical management of proximal humerus fractures were identified. Among geriatric patients undergoing ORIF, the cumulative incidence of conversion to arthroplasty within 10 years was 8.2%. The 10-year cumulative incidence of all-cause reoperation was 12.1% for ORIF patients and less than 4% for both HA and SA patients. Female sex was associated with increased risk of ORIF conversion and younger age was associated with higher all-cause reoperation. ORIF was associated with higher 30-day readmission and short-term complication rates. Over the study period, the proportion of patients treated with ORIF or SA increased while the proportion of patients treated with HA decreased. Short-term complication rates were similar between arthroplasty and ORIF patients in the later cohort (2015-2017). Conclusion The 10-year cumulative incidence of conversion to arthroplasty for geriatric patients undergoing proximal humerus ORIF as an inpatient was found to be 8.2%. All-cause reoperations, short-term complications, and 30-day readmissions were all significantly lower among patients undergoing arthroplasty, but the difference in complication rate between arthroplasty and ORIF was attenuated in more recent years. Younger age was a risk factor for reoperation and female sex was associated with increased risk of requiring conversion to arthroplasty after ORIF.

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“…After RTSA for proximal humeral fracture, however, sex-specific literature is scarce. A database analysis by Ezuma et al confirmed an increased risk for secondary surgery and any complication in male patients, although their cohort included only 175 men [ 48 ]. In a multicentre retrospective review of 898 patients, Gallinet et al reported a rate of 12.5% overall complications with a 5% revision rate, without a sub-analysis of patient sex [ 49 ].…”

Section: Discussionmentioning

confidence: 99%

Male Sex Is Associated with Higher Mortality and Increased Risk for Complications after Surgical Treatment of Proximal Humeral Fractures

Köppe

Katthagen

Rischen

et al. 2021

JCM

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Aims: The best surgical treatment of multi-fragmentary proximal humeral fractures in the elderly is a highly controversial topic. The aim of this study is to assess for sex-related differences regarding mortality and complications after reverse total shoulder arthroplasty (RTSA) and locking plate fixation (LPF). Patients and Methods: All patients from the largest German healthcare insurance (26.5 million policy holders) above the age of 65 years that were treated with LPF or RTSA after a multi-fragmentary proximal humerus fracture between January 2010 and September 2018 were included. Multivariable Cox regression models were used to assess the association of sex with overall survival, major adverse events and surgical complications. Results: A total of 8264 (15%) men and 45,707 (85%) women were followed up for a median time of 52 months. After 8 years, male patients showed significantly higher rates for death (65.8%; 95% CI 63.9–67.5% vs. 51.1%; 95% CI 50.3–51.9%; p < 0.001) and major adverse events (75.5%; 95% CI 73.8–77.1% vs. 61.7%; 95% CI 60.9–62.5%; p < 0.001). With regard to surgical complications, after adjustment of patient risk profiles, there were no differences between females and males after LPF (p > 0.05), whereas men showed a significantly increased risk after RTSA (HR 1.86; 95% CI 1.56–2.22; p < 0.001) with more revision surgeries performed (HR 1.76, 95% CI 1.46–2.12; p < 0.001) compared to women. Conclusion: The male sex is an independent risk factor for death and major adverse events after both LPF and RTSA. An increased risk for surgical complications after RTSA suggests that male patients benefit more from LPF. Sex should be considered before making treatment decisions.

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Biological sex impacts perioperative complications after reverse shoulder arthroplasty for proximal humeral fracture

Cited by 7 publications

References 42 publications

How age and gender influence proximal humerus fracture management in patients older than fifty years

How age and gender influence proximal humerus fracture management in patients older than fifty years

Short-Term Outcomes and Long-Term Implant Survival After Inpatient Surgical Management of Geriatric Proximal Humerus Fractures

Male Sex Is Associated with Higher Mortality and Increased Risk for Complications after Surgical Treatment of Proximal Humeral Fractures

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