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Orthopaedics & Traumatology: Surgery & Research
Sous presse. Epreuves corrigées par l'auteur. Disponible en ligne depuis le mercredi 13 février 2019
Doi : 10.1016/j.otsr.2018.11.016
Received : 22 January 2018 ;  accepted : 7 November 2018
Is the Charlson comorbidity index a good predictor of mortality and adverse effects in proximal humerus fractures?
 

Ana Belén Fernández-Cortiñas a, b, , Jesús Vidal Campos c , Xavier Paredes-Carnero d , Fernando Marco Martinez e
a Department of Orthopaedic Surgery, Complutense University of Madrid, Madrid, Spain 
b Cosaga Hospital and Complexo Hospitalario Universitario de Ourense, Ourense, Spain 
c Department of Orthopaedic Surgery and Traumatology, El Carmen Hospital and Complexo Hospitalario Universitario de Ourense, Ourense, Spain 
d Department of Orthopaedic Surgery, Cosaga Hospital and Complexo Hospitalario Universitario de Ourense, Ourense, Spain 
e Shoulder and Elbow Unit, Department of Orthopaedic Surgery and Traumatology, Clínico San Carlos Hospital, Complutense University of Madrid, Madrid, Spain 

Corresponding author. Carmen Legisima, 7, 4° A., 32003 Ourense, Spain.Carmen Legisima, 7, 4° A.Ourense32003Spain
Abstract
Introduction

Proximal humerus fractures (PHF) are frequent in elderly patients. This population also suffers from a series of associated comorbidities, and PHF increases morbidity and mortality. The Charlson Comorbidity Index (CCI) is a tool used for calculating comorbidity and therefore the mortality risk.

Hypothesis

Our hypothesis is that CCI is a good predictor of mortality in patients suffering from PHF, and that there is a relationship between CCI and the development of adverse events.

Patients and methods

A retrospective study with prospective data collection of 354 patients who had been diagnosed and treated for a single PHF between August 1st, 2013 and July 31st, 2015 was carried out at our hospital. The minimum follow-up was 24 months (mean 51.1 months). This study included all patients regardless the severity of the fracture, the treatment performed (surgical or conservative treatment) or whether the patient had been admitted to the hospital or was treated as an outpatient. Adverse effects and mortality data were collected and the CCI was calculated.

Results

Patients with high CCI (>5) had a higher mortality risk 4.6 (95% CI [2.4–9.0]) compared to those with CCI<5. During follow-up, 40 (11%) patients died, being the mean follow-up of the patients overall 4.3 years 95% CI [4.1–4.4]. Patients suffering from systemic complications had a higher CCI average (p =0.001) compared to those who did not present adverse effects (HR=6.6; 95% CI [3.5–12.4]). No statistically significant relationship between the type of fracture (p =0.473) and mortality was found.

Conclusion

In our study CCI has proven to be a good predictor of mortality and there is a relationship between CCI and the development of adverse effects in patients suffering from PHF, which maybe should be taken into consideration in our therapeutic decision making.

Level of evidence

IV, retrospective observational study.

The full text of this article is available in PDF format.

Keywords : Proximal humerus fractures, Comorbidity, Charlson comorbidity index, Adverse effects, Mortality




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