The importance of comprehensive geriatric assessment in predicting the outcome of patients with proximal humerus fractures

Proximal humeral fractures (PHF) are common in geriatric patients. Existing frailty scores insufficiently capture the multidimensional vulnerability influencing long-term outcomes. This study investigates if geriatric-typical characteristic complexes (GTMK), incorporating a broader range of geriatric domains, can improve prediction of long-term outcomes following PHF. In this retrospective cohort study, patients aged ≥ 65 years with PHF (ICD-10 S42.2) were identified from 2011 to 2022 using nationwide inpatient and outpatient claims data from the German BARMER health insurance database. Treatment type, GTMK, and multiple comorbidities of the patients were collected. Long-term outcomes including overall survival, major adverse events, thromboembolic events, surgical complications, and minor outpatient complications were analyzed using multivariable Cox regression and competing risk models. A total of 91,189 patients with PHF were analyzed, of whom 42.9% underwent surgical treatment. The cohort was predominantly female (84.2%) with a median age of 78 years. An increasing number of GTMK was strongly associated with higher long-term risks across all outcomes. Strong individual predictors included malnutrition for mortality (HR 1.43; 95% CI 1.36–1.51), decubital ulcers for major adverse events (HR 1.31; 95% CI 1.27–1.36), and malnutrition for thromboembolic events (HR 1.39; 95% CI 1.32–1.46). Geriatric-typical characteristics captured vulnerabilities not reflected by traditional frailty measures and substantially influenced post-fracture prognosis, highlighting their clinical relevance in risk stratification. The GTMKs malnutrition, decubital ulcers, cognitive deficits, and fluid/electrolyte disorders consistently emerged as the strongest predictors for long term adverse outcomes across multiple endpoints.