Mortality in patients over 65 with proximal humerus fractures: a systematic review of 414,379 shoulders with meta-analysis

Purpose: Proximal humerus fractures (PHFs) often lead to significant morbidity and are associated with an increased risk of mortality. The aim of this study was to assess the mortality rate in patients ≥ 65 years with PHFs. Mortality risk was assessed for 30-day/in-hospital, 1-year, and 5-year follow-up, and was compared based on treatment type. Methods: A systematic review and meta-analysis was performed in accordance with PRISMA guidelines. Studies were included if they reported mortality rates at 30-day/in-hospital, 1-year, or 5-year in patients ≥ 65 years with PHFs. Data were analysed using a random-effects model to account for anticipated heterogeneity. Subgroup analysis was performed by treatment type (operative vs non-operative). Results: Seventeen studies including 414,379 shoulders (82% female) with a mean age of 78.8 ± 2.5 reported 1-year mortality. Meta-analysis yielded a pooled 1-year mortality rate of 10% (95% CI 8.97–11.20%). Pooled 30-day/in-hospital mortality was 1.74% (95% CI 1.39–2.10%), and 5-year mortality was 36.10% (95% CI 34.50–37.70%). Mortality was lower in the operative group (7.92%, 95% CI 6.98–8.86%) compared to non-operative group (10.80%, 95% CI 9.44–12.17%), with a difference of − 2.89% (95% CI − 4.54 to − 1.23%). However, this finding should be interpreted with caution due to likely confounding by indication inherent in observational studies. Conclusion: For patients ≥ 65 years, PHFs are associated with high rates of mortality in the short-to-medium-term: 10.1% at 1 year and 36.1% at 5-year follow-up. These high mortality rates in patients ≥ 65 years support that PHFs are fragility fractures, and these patients could benefit from comprehensive geriatric assessment in defined orthogeriatric pathways.