Outpatient Surgical Fixation of Proximal Humerus Fractures Can Be Performed Without Increased Rates of Short-Term Complications or Readmissions.
Academic Article
Overview
abstract
OBJECTIVE: To delineate differences in short-term complications between outpatient versus inpatient open reduction and internal fixation (ORIF) of proximal humerus fractures. DESIGN: Retrospective database review. SETTING: Hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program database. PATIENTS: Patients in the National Surgical Quality Improvement Program database with proximal humerus fractures from 2005 to 2017. INTERVENTION: Proximal humerus fracture ORIF. MAIN OUTCOME MEASUREMENTS: Thirty-day readmission, reoperation, thromboembolic events, and other complications. RESULTS: In total, 920 outpatient and 2490 inpatient ORIF cases were identified. The proportion of outpatient proximal humerus fracture ORIF increased throughout the years from 6.67% in 2007 to 34.89% in 2017. Each outpatient case was propensity-score-matched with one inpatient case by age, sex, functional status, American Society of Anesthesiologists classification, smoking status, diabetes mellitus type, hypertension, chronic obstructive pulmonary disease, and dyspnea on exertion. After matching, there were 920 outpatient and 920 inpatient cases. Statistical analysis revealed no significant difference in complications including reoperation (1.63% vs. 2.50%), thromboembolic events (0.65% vs. 0.65%), and 30-day readmissions (2.93% vs. 2.69%) between outpatient versus matched inpatient procedures (all P > 0.05). The only significant finding was a lower rate of blood transfusion in outpatient procedures (0.54%) compared with inpatient procedures (4.02%) (P < 0.001). CONCLUSIONS: The perioperative outcomes assessed here support the conclusion that ORIF for proximal humerus fractures can be performed in the outpatient setting without increased rates of 30-day perioperative complications or readmissions compared with inpatient procedures. However, it is worth noting that the majority of outpatient cases were younger than the average geriatric proximal humerus fracture patient. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
