Study compares outcomes for surgical vs. non-surgical treatment of broken shoulder

March 10, 2015

Among patients with a displaced fracture in the upper arm near the shoulder (proximal humeral), there was no significant difference between surgical treatment and nonsurgical treatment in patient-reported outcomes over two years following the fracture, results that do not support the trend of increased surgery for patients with this type of fracture, according to a study in the March 10 issue of JAMA.

Proximal humeral fractures account for 5 percent to 6 percent of all adult fractures; an estimated 706,000 occurred worldwide in 2000. The majority occur in people older than 65 years, and the age-specific incidence of these fractures is increasing. Approximately half of these fractures are displaced, the majority of which involve the surgical neck (located on the upper portion of the humerus). Surgical treatment is being increasingly used, contributing to increased treatment costs for upper limb fractures. A review of results from randomized clinical trials found insufficient evidence to conclude whether surgical intervention produces consistently better outcomes than nonsurgical treatment, according to background information in the article.

Amar Rangan, F.R.C.S. (Tr. & Orth.), of James Cook University Hospital, Middlesbrough, England, and colleagues randomly assigned 250 patients (average age, 66 years) who sustained a displaced fracture of the proximal humerus involving the surgical neck to surgical treatment (fracture fixation or humeral head replacement) or nonsurgical treatment (sling immobilization). Standardized outpatient and community-based rehabilitation was provided to both groups. Patients were followed up for 2 years and 215 had complete follow-up data. The data for 231 patients (114 in surgical group and 117 in nonsurgical group) were included in the primary analysis.

The researchers found that there were no statistically or clinically significant differences between surgical and non-surgical treatment either overall or at individual time points (at 6, 12, and 24 months) for the Oxford Shoulder Score (OSS), a shoulder-specific outcome measure that provides a total score based on the patient's subjective assessment of pain and function. In addition, there were no clinically or significant differences on measures of health-related quality of life, complications related to surgery or shoulder fracture, complications requiring secondary surgery or treatment, and death.

Ten medical complications (2 cardiovascular events, 2 respiratory events, 2 gastrointestinal events, and 4 others) occurred in the surgical group during the postoperative hospital stay.

"These results do not support the trend of increased surgery for patients with displaced fractures of the proximal humerus," the authors conclude.
-end-
(doi:10.1001/jama.2015.1629; Available pre-embargo to the media at http://media.jamanetwork.com)

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

The JAMA Network Journals

Related Surgery Articles from Brightsurf:

Decision conflict before cancer surgery correlates with lower activity after surgery
Nearly one-third of cancer patients who decide to undergo surgery for their condition may have second thoughts, and this decision conflict may lead to less favorable treatment outcomes in both the near- and long-term, according to a team of investigators at Massachusetts General Hospital and Ariadne Labs.

Examining association between weight loss before bariatric surgery, risk of death after surgery
Researchers looked at whether a patient's body weight and weight loss before bariatric surgery were associated with risk of death within 30 days after surgery using data from nearly 500,000 patients in the US and Canada.

Guidelines for thyroid surgery published in Annals of Surgery
The first set of comprehensive, evidence-based clinical guidelines for surgical treatment of thyroid disease -- developed by an expert panel assembled by the American Association of Endocrine Surgeons (AAES) -- was published today by Annals of Surgery.

Colorectal surgery patients use fewer opioids, report less pain with enhanced recovery after surgery
Colorectal surgery patients who were a part of an enhanced recovery after surgery (ERAS) program had less pain, while using nearly half as many opioids, according to research being presented at the ANESTHESIOLOGY® 2019 annual meeting.

Video assisted lung surgery reduces complications and hospital stays compared to open surgery
Video-assisted thoracic surgery is associated with lower in-hospital complications and shorter length of stay compared with open surgery among British patients who were diagnosed at an early stage of lung cancer, according to research presented today the IASLC 2019 World Conference on Lung Cancer, hosted by the International Association for the Study of Lung Cancer.

Most deaths related to noncardiac surgery occur after surgery and after discharge from hospital
It's not the operating room that is risky for patients undergoing noncardiac surgery; it's the recovery period.

Study looks at opioid use after knee surgery
A small study looked at whether reducing the number of opioid tablets prescribed after knee surgery would reduce postoperative use and if preoperative opioid-use education would reduce it even more.

Surgery patients are getting older every year
A new BJS (British Journal of Surgery) analysis reveals that people undergoing surgery in England are getting older at a faster rate than the general population.

Children requiring thyroid surgery have better outcomes at high-volume surgery centers
New research recently published in the Journal of Pediatric Surgery found that post-operative success rates of pediatric thyroid patients, particularly children who require a thyroidectomy, correlate with the institution's patient volume.

Do negative public attitudes toward weight loss surgery stop some patients from having surgery?
Most patients who qualify for weight loss surgery don't have the procedure despite its safety and effectiveness.

Read More: Surgery News and Surgery Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.