Long-term mortality rates in patients with proximal humerus fracture managed acutely with reverse shoulder arthroplasty and hemiarthroplasty.

Abstract

Background: Proximal humerus fractures (PHFs) are common in the elderly, often requiring acute arthroplasty, such as reverse shoulder arthroplasty (RSA) or hemiarthroplasty (HA). Understanding long-term mortality trends in these patients is crucial for improving care and informing health economic analyses.

Methods: Data from the Australian Orthopaedic Association National Joint Replacement Registry (2004-2022) were analysed. Patients who underwent primary RSA or HA for PHF were included. Mortality rates were calculated using standardised mortality ratios (SMRs) and compared to the general Australian population, with subgroup analyses based on age, gender, body mass index (BMI), and American Society of Anaesthesiologists (ASA) score.

Results: A total of 7868 RSA and 3006 HA procedures were reviewed. PHF patients undergoing RSA or HA had significantly higher mortality rates than the general population, with an increasing trend over 15 years. Higher mortality was associated with younger age, male gender, extreme BMI, and higher ASA scores.

Conclusion: PHF patients receiving acute arthroplasty face higher long-term mortality, influenced by demographic and clinical factors. These findings underscore the need for optimised care and healthcare policy adjustments for this vulnerable group. Further research is required to establish causality and improve outcomes.