Despite an increasing prevalence of patients sustaining pathologic fractures of neoplastic origin, few studies have investigated 30-day postoperative complication profiles following surgical treatment of pathologic humerus fractures. The purposes of this study were to use a large nationally representative database to determine short-term complication profiles after surgical treatment of pathologic humerus fractures and assess how these complications compared to more commonly studied native humerus fractures.
Using the National Surgical Quality Improvement Program database, we identified 30,866 patients who underwent surgical treatment for either pathologic (n=449) or native humerus fractures (n=30,417) from 2007-2017. 30-day postoperative complication profiles were ascertained and compared between the two groups using chi-squared analyses. Three logistic regression models were then performed to determine which complications were primarily attributable to the pathologic fracture itself versus the increased comorbidity burden faced by these patients.
Pathologic humerus fracture patients experienced significantly higher rates of death (6.0% vs. 0.3%, p<0.001), serious adverse events (12.2% vs. 3.7%, p<0.001), minor complications (15.8% vs. 4.8%, p<0.001), extended postoperative lengths of stay (42.3% vs. 21.3%, p<0.001), discharge to facilities (22.3% vs. 13.5%, p<0.001), and readmissions (14.8% vs. 3.4%, p<0.001) compared to patients with native humerus fractures. With respect to specific complications, patients with pathologic fractures were at significantly higher risk of pulmonary complications (1.3% vs. 0.3%, p<0.001), renal complications (0.7% vs. 0.2%, p=.007), thromboembolic complications (1.6% vs. 0.6%, p=0.01), and transfusions (15.1% vs. 4.1%, p<0.001).
After surgical treatment, patients with pathologic humerus fractures had significantly higher complication rates compared to native humerus fractures, suggesting that guidelines and treatment algorithms for native humerus fractures may not be generalizable for those of pathologic origin. These findings have significant implications for preoperative patient counseling and may be used to negotiate higher reimbursements rates for these patients given a significantly higher morbidity and mortality than was previously described in literature. Postoperatively, orthopedic surgeons should closely monitor patients with pathologic humerus fractures for deep vein thrombosis, renal complications, and pulmonary complications, utilize blood sparing techniques, and employ a multidisciplinary approach to help manage and prevent a more heterogenous profile of postsurgical complications.
Level III; Retrospective Cohort Design using Large Database; Treatment Study.

Copyright © 2020. Published by Elsevier Inc.

References

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