Which Factors Influence the Need for Inpatient Aftercare of Elderly Patients After Hospital Treatment for Proximal Humerus Fractures?

Abstract

Introduction: 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.

Materials and methods: 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 ('Home') vs being discharged into aftercare ('Aftercare'). Differences regarding demographic and clinical data were analysed. Odds ratios (OR) of influencing factors (adjusted for age) were calculated by logistic regression analysis.

Results: 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]; P < .001), anterior surgical approach (OR 6.05 [1.93,27.1]; P < .006), duration of surgery (OR 1.01 per min [1.00,1.02]; P < .012), non-surgical complications (OR 3.82 [1.60,9.49]; P < .003), length of stay (OR 1.12 per day [1.04,1.22]; P < .005), ICU stay (OR 3.15 [1.71,6.00]; P < .001) and reversely surgery (OR 0.39 [0.19,0.80]; P < .010).

Conclusion: 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.