Adoption of reverse total shoulder arthroplasty for surgical treatment of proximal humerus fractures differs by patient race

Ryan T Halvorson; Favian Su; Ramesh B Ghanta; Edgar Garcia-Lopez; Gopal Ram Lalchandani; Lauren Michelle Shapiro

doi:10.1016/j.jse.2024.06.003

Adoption of reverse total shoulder arthroplasty for surgical treatment of proximal humerus fractures differs by patient race

J Shoulder Elbow Surg. 2024 Aug 7:S1058-2746(24)00533-0. doi: 10.1016/j.jse.2024.06.003. Online ahead of print.

Authors

Ryan T Halvorson¹, Favian Su¹, Ramesh B Ghanta¹, Edgar Garcia-Lopez¹, Gopal Ram Lalchandani¹, Lauren Michelle Shapiro²

Affiliations

¹ Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA.
² Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA. Electronic address: Lauren.Shapiro@ucsf.edu.

PMID: 39097137
DOI: 10.1016/j.jse.2024.06.003

Abstract

Background: Reverse total shoulder arthroplasty (rTSA) has gained popularity for the operative treatment of proximal humerus fractures (PHF). The purpose of this study was to compare racial differences in surgical management of PHF between open reduction and internal fixation (ORIF), hemiarthroplasty, and rTSA. Our hypothesis was that there would be no difference in fixation by race.

Methods: The National Surgical Quality Improvement Program database was queried for ORIF, rTSA, and hemiarthroplasty between 2006 and 2020 for patients with a PHF. Race, ethnicity, age, sex, body mass index, and American Society of Anesthesiologists (ASA) class were recorded. Chi squared tests were performed to assess relationships between patient factors and operative intervention. Factors significant at the 0.10 level in univariable analyses were included in a multivariable multinomial model to predict operative intervention.

Results: Seven thousand four hundred ninety-nine patients underwent surgical treatment for a PHF, including 526 (7%) undergoing hemiarthroplasty, 5011 (67%) undergoing ORIF, and 1962 (26%) undergoing rTSA. 27% of white patients with PHF underwent rTSA compared to 21% of Black patients, 16% of Asian patients, and 14% of Native American and Alaskan Native patients (P < .001). In the multivariable analysis, utilization of rTSA increased over time (OR 1.2 per year since 2006, P < .001) and hemiarthroplasty decreased over time (OR 0.86 per year since 2006, P < .001). Non-White patients had significantly lower odds of undergoing rTSA vs. ORIF (OR 0.75, 95% CI 0.58-0.97), as did male patients (OR 0.77, 95% CI 0.66-0.88). Patients over 65 (OR 3.86, 95% CI 3.39-4.38), patients with higher ASA classifications (ASA2: OR 3.24, 95% CI 1.86-5.66, ASA3: OR 4.77, 95% CI 2.74-8.32, ASA4: OR 5.25, 95% CI 2.89-9.54), and patients who were overweight (OR 1.33, 95% CI 1.14-1.55) or obese (OR 1.52, 95% CI 1.32-1.75) had higher odds of undergoing rTSA vs. ORIF.

Discussion: As utilization of rTSA increases, understanding disparities in surgical treatment of PHF is crucial to improving outcomes and equitable access to emerging orthopedic technologies. While patient factors such as age, body mass index, and comorbidities are known to directly impact outcomes and thus may be predictive of the type of surgical intervention, patient race should not dictate treatment.

Keywords: Reverse total shoulder; hemiarthroplasty; proximal humerus fracture; racial disparities; shoulder arthroplasty, trauma.