Readmission, reoperation, and nonhome discharge rates in patients receiving surgical treatment for proximal humerus fractures

Background: Proximal humerus fractures (PHFs) are generally surgically treated with open reduction internal fixation (ORIF), hemiarthroplasty (HA), or total shoulder arthroplasty (TSA). Diverse fracture patterns and a high prevalence in the elderly population make it difficult to establish objective guidelines for the decision to undergo surgical treatment. The purpose of this study was to investigate risk factors associated with readmission, reoperation, and nonhome discharge following ORIF, HA, and TSA for PHFs. Methods: Data on all patients who underwent ORIF, TSA, or HA for treatment of closed PHF between 2015 and 2017 were obtained by querying the American College of Surgeons National Surgical Quality Improvement database. Rates of postoperative readmission, nonhome discharge, and reoperation within 30 days were collected. Multivariate logistic regression was employed to identify predictors of readmission, nonhome discharge, and reoperation. Results: A total of 2825 patients were included in this study: 1829 underwent ORIF, 707 underwent TSA, and 289 underwent HA. The significant predictors for readmission were having an American Society of Anesthesiologists class ≥ 3 (odds ratio [OR] 1.95, P =.003) and being of dependent functional status (OR 3.15, P <.001). The significant predictors for reoperation were male sex (OR 2.41, P <.001) and dependent functional status (OR 2.92, P =.006). The significant predictors for nonhome discharge were age 66-80 years (OR 7.00, P <.001), age ≥ 81 years (OR 16.31, P <.001), American Society of Anesthesiologists ≥3 (OR 2.34, P <.001), dependent functional status (OR 2.48, P <.001), and inpatient status (OR 3.32, P <.001). TSA showed slightly higher rates of nonhome discharge than HA and ORIF. Conclusion: Significant risk factors for readmission, reoperation, and nonhome discharge within 30 days following surgical treatment for PHF were identified. Additionally, TSA was significantly associated with nonhome discharge compared with HA and ORIF.