Treatment of humerus fractures in the elderly: A systematic review covering effectiveness, safety, economic aspects and evolution of practice
| Autor: | Carl Ekholm, Lena Zidén, Agneta Brolund, Cecilia Mellstrand Navarro, Karin Stenström, Emelie Heintz, Peter Nordström, Per Olof Josefsson, Emin Hoxha Ekström, Lina Leander |
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| Rok vydání: | 2018 |
| Předmět: |
Male
Technology Assessment Biomedical Cost-Benefit Analysis medicine.medical_treatment Geographical locations Elderly Mathematical and Statistical Techniques 0302 clinical medicine Quality of life Medicine and Health Sciences Orthopedic Procedures 030212 general & internal medicine Musculoskeletal System Aged 80 and over Geriatrics 030222 orthopedics Multidisciplinary Statistics Metaanalysis Middle Aged Europe Treatment Outcome medicine.anatomical_structure Meta-analysis Physical Sciences Shoulder Fractures Medicine Female Anatomy Safety Research Article Humeral Fractures medicine.medical_specialty Science Humerus fracture Surgical and Invasive Medical Procedures Research and Analysis Methods Arthroplasty 03 medical and health sciences Musculoskeletal System Procedures mental disorders medicine Humans Humerus European Union Statistical Methods Skeleton Aged Sweden business.industry Biology and Life Sciences medicine.disease Health Care Age Groups Strictly standardized mean difference People and Places Orthopedic surgery Quality of Life Physical therapy Population Groupings business Mathematics |
| Zdroj: | PLoS ONE, Vol 13, Iss 12, p e0207815 (2018) PLoS ONE |
| ISSN: | 1932-6203 |
| Popis: | Objectives The objective of this Health Technology Assessment was to evaluate effectiveness, complications and cost-effectiveness of surgical or non-surgical treatment for proximal, diaphyseal or distal fractures of the humerus in elderly patients. Secondary objectives were to evaluate the intervention costs per treatment of proximal humerus fractures (PHF) and to investigate treatment traditions of PHF in Sweden. Methods and findings The assessment contains a systematic review of clinical and health economic studies comparing treatment options for humerus fractures in elderly patients. The results regarding the effectiveness of treatments are summarized in meta-analyses. The assessment also includes a cost analysis for treatment options and an analysis of registry data of PHF. For hemiarthroplasty (HA) and non-operative treatment, there was no clinically important difference for moderately displaced PHF at one-year follow-up regarding patient rated outcomes, (standardized mean difference [SMD]) -0.17 (95% CI: -0.56; 0.23). The intervention cost for HA was at least USD 5500 higher than non-surgical treatment. The trend in Sweden is that surgical treatment of PHF is increasing. When functional outcome of percutaneous fixation/ plate fixation/prosthesis surgery and non-surgical treatment was compared for PHF there were no clinically relevant differences, SMD -0.05 (95% CI: -0.26; 0.15). There was not enough data for interpretation of quality of life or complications. Evidence was scarce regarding comparisons of different surgical options for humerus fracture treatment. The cost of plate fixation of a PHF was at least USD 3900 higher than non-surgical treatment, costs for complications excluded. In Sweden the incidence of plate fixation of PHF increased between 2005 and 2011. Conclusions There is moderate/low certainty of evidence that surgical treatment of moderately displaced PHF in elderly patients has not been proven to be superior to less costly non-surgical treatment options. Further research of humerus fractures is likely to have an important impact. (Less) |
| Databáze: | OpenAIRE |
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