Evidence map›Paper›PMID 41673641›Full record

ArticleBMC health services research2026

The impact of prior level of care on the course of proximal humeral fractures in older patients: an analysis based on health insurance claims data.

Janette Iking, J Christoph Katthagen, Jeanette Koeppe, Karen Fischhuber, Jan P Happe, Ursula Marschall, Michael J Raschke, Josef Stolberg-Stolberg

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Article in BMC health services research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

8 authors.

Janette Iking *Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W1, 48149, Münster, Germany.
J Christoph Katthagen *Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W1, 48149, Münster, Germany. christoph.katthagen@ukmuenster.de.
Jeanette KoeppeResearch Group "Mathematical Surgery", University Hospital Münster, University of Münster, Münster, Germany.
Karen FischhuberResearch Group "Mathematical Surgery", University Hospital Münster, University of Münster, Münster, Germany.
Jan P HappeDepartment of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W1, 48149, Münster, Germany.
Ursula MarschallBARMER Institute for Health System Research, Lichtscheider Straße 89, 42285, Wuppertal, Germany.
Michael J RaschkeDepartment of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W1, 48149, Münster, Germany.
Josef Stolberg-StolbergDepartment of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building W1, 48149, Münster, Germany.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe proximal humeral fracture (PHF) is the third most common fracture in older individuals. Prior level of care (LoC) and associated comorbidities may have an impact on patient outcome and prognosis.

methodsRetrospective German health insurance data from patients with PHF aged 65 years and older between 01/17 to 09/22 were analysed. The primary endpoints included overall survival (OS), major adverse events (MAEs), thromboembolic events (TEs), and surgery- or injury-related complications. All endpoints were analysed using multivariable models.

resultsA total of 55,798 patients (median age 79 years; 84% female) were included. Prior to PHF, 68% had no LoC (LoC I 3%, LoC II 12%, LoC III 11%, LoC IV 6%, LoC V 1%), and 8% were living in a nursing home. With increasing LoC, the proportion of patients receiving non-operative treatment (no LoC 52%, LoC I 53%, LoC II 62%, LoC III 64%, LoC IV 71%, LoC V 76%) and the likelihood of a worse outcome increased. Both, mortality rates (1-year mortality: no LoC 4%, LoC I 12%, LoC II 19%, LoC III 29%, LoC IV 41%, LoC V 50%) and rates of MAEs increased drastically with increasing LoC. Multivariable analyses confirmed that increasing LoC was associated with a greater risk of death, MAEs, and TEs (all p < 0.001).

conclusionPrior LoC has a significant effect on the course of PHF and the choice of treatment method in older individuals. This should be considered when making treatment decisions. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Indexed as

Shoulder FracturesAgedAged, 80 and overComorbidityFemaleGermanyHumansInsurance Claim ReviewMaleRetrospective Studiescomplication ratesGeriatric surgeryHealth service researchlevel of careMultivariable regression analysisproximal humeral fractureReal-world analysis

Identifiers

PMID41673641
PMCPMC12937572

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