老人患者における近位上腕骨骨折の短期予後を予測する老年医学的特徴複合体

Geriatric-typical multimorbidity (GTMM) categorizes older patients with multiple geriatric syndromes, but its impact on PHF outcomes remains unexplored. This study evaluates GTMM's influence on PHF patients within three months after fracture, aiming to improve geriatric care strategies.

Patients ≥65 years with a PHF diagnosis (ICD S42.2) between 2011 and 2022 were included. GTMMs were collected within two years prior to PHF. Patients were categorized into five treatment groups based on surgical intervention (reverse total shoulder arthroplasty (RTSA), locked plate fixation (LPF, sLPF), other fracture fixations) or non-surgical management. A multivariable Cox hazard model analyzed associations between treatment groups, GTMMs, and three-month outcomes: complications, major adverse events (MAE), thromboembolic events (TE), and mortality.

Between January 2011 and December 2022, 95,324 patients were identified with PHF, 43% of whom underwent surgery. The median patient age was 79, and 70% were categorized as geriatric. Mortality within three months was 4.3% (95%-CI: 4.15-4.41%), with major adverse events (MAE) and thromboembolic events (TE) occurring in 7.1% (95%-CI: 6.90-7.23%) and 5.6% (95%-CI: 5.41-5.70%) of cases, respectively. Geriatric-typical multimorbidity (GTMK) cognitive deficits were an independent risk associated factor for inferior outcome in surgically treated patients, while conditions like incontinence and malnutrition resulted in increased rates of mortality, MAEs, and TEs in all patients (p < 0.05).

GTMKs are associated with worse outcome in both operative and non-operative treated patients. The impact of GTMKs, such as cognitive deficits, incontinence, decubitus ulcers and malnutrition, were found to be risk-associated factors.