Association of Surgical Treatment With Adverse Events and Mortality Among Medicare Beneficiaries With Proximal Humerus Fracture

Key Points Question Are higher rates of surgery for proximal humerus fracture associated with adverse events, mortality, and cost? Findings In this comparative effectiveness research study of 72 823 fee-for-service Medicare beneficiaries with a proximal humerus fracture in 2011, instrumental variable analysis showed that higher rates of surgery were significantly associated with increased costs, adverse event rates, and mortality risk at 1 year. These associations were even more striking for older patients, those with higher comorbidity burdens, and those with increased frailty. Meaning Orthopedic surgeons should be aware of the harms of extending the use of surgery to more clinically vulnerable patient subgroups.