The Proximal Humerus Outcome Score at One Year (POSY) Predicts Which Patients Have Poor Functional Outcomes Following
Nina D Fisher1, Adam Driesman1, Hesham Saleh1
1Orthopedic Surgery, New York University (NYU) Langone Health, New York City, USA.
Insights
A new POSY score predicts functional outcomes after proximal humerus fracture surgery. Patients scoring over 50% face high risk for poor results, aiding resource allocation.
Area of Science:
- Orthopedic surgery
- Trauma surgery
- Medical prediction modeling
Background:
- Predicting long-term outcomes after proximal humerus fracture surgery is crucial for identifying at-risk patients.
- A simple, preoperative scoring system is needed to forecast functional outcomes post-operative management.
Purpose of the Study:
- Develop and validate a predictive score using preoperative data for functional outcomes in surgically treated proximal humerus fractures.
- Identify key preoperative factors influencing patient outcomes.
Main Methods:
- Prospective enrollment of 165 patients undergoing locked proximal humerus plate fixation over 12 years.
- Utilized logistic regression to develop a predictive formula based on preoperative data, with poor outcomes defined by DASH scores >10 points above the mean.
- Calculated Area Under the Receiver Operator Characteristic Curve (AUROC) to assess predictive accuracy.
Main Results:
- Older age, higher BMI, age-adjusted CCI, non-Caucasian race, lack of college degree, unemployment, and worker's compensation cases were significant predictors of poor outcomes.
- The final logistic regression model demonstrated strong predictive capacity (AUROC = 0.839).
- A POSY score cutoff of >50% identified a high-risk group, with 73.1% experiencing poor functional outcomes.
Conclusions:
- The POSY score effectively predicts one-year or greater functional outcomes following surgical treatment of proximal humerus fractures.
- Patients with a POSY score above 50% are at high risk for poor functional outcomes.
- The POSY score can guide resource utilization and potentially improve patient outcomes in value-based care settings.
Background:
The ability to predict long-term outcomes following surgical fixation of proximal humerus fractures would help identify patients at risk of poor functional outcomes. The purpose of this study was to develop a simple score based on preoperative data that can accurately predict functional outcomes for patients following operative management of proximal humerus fractures.
Methods:
Over a 12-year period, all proximal humerus fractures surgically treated with a locked proximal humerus plate at a single institution were enrolled in a prospective database. Inclusion criteria in this analysis were any patient with a minimum of a one-year functional outcome score. Patients were assigned to the poor outcome cohort if their Disabilities of the Arm, Shoulder, and Hand (DASH) score at that time point was greater than 10 points above the mean DASH score. Logistic regression was used to build a predictive formula for cohort membership using p < 0.15 and an area under the receiver operator characteristic curve (AUROC) value was calculated to define the overall predictive capacity.
Results:
A total of 165 patients with an average age of 60.91±13.5 years met the inclusion criteria, with 47 (28.5%) patients assigned to the poor outcome group and 118 (71.5%) patients assigned to the good outcome group. Older age (p = 0.088), BMI (p = 0.019), age-adjusted CCI (p = 0.001), non-Caucasian race (p = 0.017), no college degree (p < 0.0005), unemployed (p < 0.0005), and worker's compensation case (p = 0.002) were found to be significant predictors of poorer outcome and were used to create a final formula through logistic regression which predicted the probability of a poor outcome (Nagelkerke R Square = 0.403; Hosmer and Lemeshow = 0.902; AUROC = 0.839 [CI: 0.762-0.917]). Once each patient was assigned a score, cutoff values were defined that divided the cohort into three groups. High-risk patients had a score above 50%, and 19 (73.1%) of these patients had a poor outcome.
Conclusions:
The POSY score is a tool that can predict the functional outcome at one year or greater following surgical intervention for a proximal humerus fracture. Patients who score above 50% are considered at high risk for a poor functional outcome. In the era of value-based care, the POSY score may be used to direct resource utilization while improving outcomes.
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