Geriatric proximal humerus fracture operative management: a Truven Health Analytics database study (2015-2020)

Abstract

The purpose of this study is to assess the trends in operative management of geriatric (≥65 years) proximal humerus fractures during a six-year period (2015-2020) within an insurance claims database. This retrospective database cohort study utilized data gathered from the 2015-2020 IBM Truven MarketScan Commercial and IBM Truven MarketScan Medicare Supplemental databases. The ICD10 data was correlated to the CPT code for shoulder arthroplasty [proximal humeral prosthetic replacement (23616), shoulder hemiarthroplasty (HA)(23470), reverse total shoulder arthroplasty (rTSA)(23472)] or open reduction internal fixation (ORIF) [open treatment of proximal humerus fracture with internal fixation (23615), open treatment of proximal humerus fracture-dislocation with internal fixation (23680)] We investigated the number of proximal humerus fracture operative cases per year, percent arthroplasty used per year, rTSA and HA per year, hospital cost information as well as percent arthroplasty per US geographic region. A total of 8,057 operative proximal humerus fractures cases were identified in 7,697 patients over 65 years of age, with 0.45% (360/8,057) being bilateral. There was a 40.8 % decrease in the rate of operative management of proximal humerus fractures between the first half (2015-2017, 1687.3 +/- 146.6) and second half of the study period (2018-2020, 998.3 +/- 258.7). Arthroplasty accounted for 78.7% of all surgeries, and 91% of those being rTSA. The total number of cases, rTSA and ORIF performed decreased per year (p=.01). The downward trend of percent ORIF per year approached significance (p=.054). Arthroplasty was a more expensive payment for total case option by almost $850.00 (p=.001). There was a larger percentage of arthroplasty performed in the Northeast, and North central US geographic regions. Despite the rise of both the elderly population and related geriatric proximal humerus fractures, there were less operatively represented in this insurance claims database across the six-year period. There may be a trend to utilize less ORIF when addressing these fractures. Although it incurred a higher in-hospital cost, Arthroplasty was being performed at a higher percentage in the Northeast, and North central regions of the United States.