Trends in surgical management of proximal humeral fractures in the Medicare population

A nationwide study of records from 2009 to 2012

Samuel Rosas, Tsun Yee Law, Jennifer Kurowicki, Nate Formaini, Steven Kalandiak, Jonathan C. Levy

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Background: Surgical management of proximal humeral fractures has reportedly increased in recent years. Much of this growth relates to a growing elderly population, together with the introduction of modern implants, such as locking plates and, recently, introduction of reverse shoulder arthroplasty (RSA). This study evaluated trends in surgical management of proximal humeral fractures from 2009 to 2012 by analyzing the use of hemiarthroplasty (HA), RSA, and osteosynthesis (open reduction with internal fixation [ORIF]) within the Medicare patient population. Methods: We retrospectively reviewed a comprehensive Medicare patient population database within the PearlDiver supercomputer (Warsaw, IN, USA) for proximal humeral fractures treated with HA, RSA, or ORIF. Total use, annual utilization rates, age, and gender were investigated. Results: Within the study period, 32,150 proximal humeral fractures were treated operatively, with no significant change in annual volume (P = .119). The percentage of fractures treated surgically decreased significantly from 16.2% to 13.9% (P <.001). The utilization rate decreased significantly for HA from 52% to 39% (P <.001), increased significantly for RSA from 11% to 28% (P <.001), and did not change significantly for ORIF (P = .164). The utilization rate of RSA nearly tripled for patients older than 65 years (11% to 29%) and doubled for patients younger than 65 (6% to 12%). Conclusion: From 2009 to 2012, utilization rates of ORIF remained fairly constant. HA remains the most commonly used surgical treatment for proximal humeral fractures in the Medicare population, but its use has declined significantly. This decline has been offset by a corresponding increase in RSA. Level of evidence: Descriptive Epidemiology Study, Large Database Analysis.

Original languageEnglish (US)
Pages (from-to)608-613
Number of pages6
JournalJournal of Shoulder and Elbow Surgery
Volume25
Issue number4
DOIs
StatePublished - Apr 1 2016

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Shoulder Fractures
Medicare
Arthroplasty
Hemiarthroplasty
Population
Databases
Epidemiology
Growth

Keywords

  • Hemiarthroplasty
  • Proximal humeral fractures
  • Reverse shoulder arthroplasty
  • Total shoulder arthroplasty

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Surgery

Cite this

Trends in surgical management of proximal humeral fractures in the Medicare population : A nationwide study of records from 2009 to 2012. / Rosas, Samuel; Law, Tsun Yee; Kurowicki, Jennifer; Formaini, Nate; Kalandiak, Steven; Levy, Jonathan C.

In: Journal of Shoulder and Elbow Surgery, Vol. 25, No. 4, 01.04.2016, p. 608-613.

Research output: Contribution to journalArticle

Rosas, Samuel ; Law, Tsun Yee ; Kurowicki, Jennifer ; Formaini, Nate ; Kalandiak, Steven ; Levy, Jonathan C. / Trends in surgical management of proximal humeral fractures in the Medicare population : A nationwide study of records from 2009 to 2012. In: Journal of Shoulder and Elbow Surgery. 2016 ; Vol. 25, No. 4. pp. 608-613.
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abstract = "Background: Surgical management of proximal humeral fractures has reportedly increased in recent years. Much of this growth relates to a growing elderly population, together with the introduction of modern implants, such as locking plates and, recently, introduction of reverse shoulder arthroplasty (RSA). This study evaluated trends in surgical management of proximal humeral fractures from 2009 to 2012 by analyzing the use of hemiarthroplasty (HA), RSA, and osteosynthesis (open reduction with internal fixation [ORIF]) within the Medicare patient population. Methods: We retrospectively reviewed a comprehensive Medicare patient population database within the PearlDiver supercomputer (Warsaw, IN, USA) for proximal humeral fractures treated with HA, RSA, or ORIF. Total use, annual utilization rates, age, and gender were investigated. Results: Within the study period, 32,150 proximal humeral fractures were treated operatively, with no significant change in annual volume (P = .119). The percentage of fractures treated surgically decreased significantly from 16.2{\%} to 13.9{\%} (P <.001). The utilization rate decreased significantly for HA from 52{\%} to 39{\%} (P <.001), increased significantly for RSA from 11{\%} to 28{\%} (P <.001), and did not change significantly for ORIF (P = .164). The utilization rate of RSA nearly tripled for patients older than 65 years (11{\%} to 29{\%}) and doubled for patients younger than 65 (6{\%} to 12{\%}). Conclusion: From 2009 to 2012, utilization rates of ORIF remained fairly constant. HA remains the most commonly used surgical treatment for proximal humeral fractures in the Medicare population, but its use has declined significantly. This decline has been offset by a corresponding increase in RSA. Level of evidence: Descriptive Epidemiology Study, Large Database Analysis.",
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