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Mortality and healthcare utilization after proximal humeral fractures in patients aged 65 years and older: a register-based cohort study

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Abstract

Purpose

Proximal humeral fractures are associated with substantial pain, impaired mobility, and reduced quality of life, yet no widely accepted guidelines for post-fracture care exist. This study investigates one-year mortality and identifies pre-fracture risk factors associated with mortality. Further, it examines changes in healthcare utilization and associated risk factors across hospitals, municipalities, and primary care before and after the fracture.

Methods

Patients aged ≥65 years with proximal humeral fracture were identified from the CROSS-TRACKS cohort. One-year mortality was analysed using Kaplan–Meier and Cox regression, adjusting for sex, age, Charlson Comorbidity Index (CCI), civil status, and residential status. Changes in hospital contacts, municipal services, and primary care contacts were assessed using paired t-tests, and their associations with sex, age, CCI, civil status, and residential status were examined using multiple linear regression.

Results

One-year mortality was 11.6% (95% confidence interval (CI) 10.8; 12.3). Male sex, older age, higher CCI, unmarried status, and nursing home residency were associated with increased mortality. From the year before to the year after the fracture, hospital contacts increased by a mean of 2.1 (95% CI: 2.0; 2.3), municipal services by 339.1 (95% CI: 294.6; 383.5), and primary care contacts by 4.4 (95% CI: 3.9; 4.8). Older age and higher CCI were associated with increased healthcare utilization.

Conclusion

Patients with proximal humeral fractures had high one-year mortality and increased healthcare utilization. Older age and high CCI were associated with both outcomes. These findings highlight the need for standardized, evidence-based protocols with patient-centred principles for this frail population.

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Data availability

The datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request.

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Acknowledgements

The authors acknowledge the CROSS-TRACKS Research Group and the steering committee at Horsens Regional Hospital, Denmark, for data infrastructure, methodological, and research inputs.

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Authors and Affiliations

  1. Department of Clinical Medicine, Aarhus University, Aarhus, Denmark

    Jesper Lindberg Jensen, Pia Kjær Kristensen, Lone Winther Lietzen, Inger Mechlenburg & Martin Gade Stisen

  2. Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark

    Jesper Lindberg Jensen, Lisa Solgaard Nøhr, Pia Kjær Kristensen, Inger Mechlenburg & Martin Gade Stisen

  3. Department of Geriatrics, Aarhus University Hospital, Aarhus, Denmark

    Lone Winther Lietzen

  4. Research Unit, CROSS-TRACKS, Regional Hospital Horsens, Horsens, Denmark

    Martin Gade Stisen

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Contributions

MGS, PKK, IM, and LWL contributed to the conceptualization of the study. Study design was undertaken by MGS, PKK, IM, LWL, and JLJ. PKK was responsible for data acquisition. Data management was performed by MGS, JLJ, and LSN. JLJ, LSN, and MGS conducted the data analysis and interpretation. JLJ drafted the manuscript. All authors (MGS, PKK, IM, LWL, and LSN) contributed to critical revision of the manuscript. Supervision was provided by MGS, PKK, and IM.

Corresponding author

Correspondence to Jesper Lindberg Jensen.

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The authors declare no conflict of interests.

Ethical approval

Approval from an ethics committee is not required for registry-based studies according to Danish law. The study was approved by the Danish Data Protection Agency (Journal No. 1-16-02-166-23).

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Jensen, J., Nøhr, L., Kristensen, P. et al. Mortality and healthcare utilization after proximal humeral fractures in patients aged 65 years and older: a register-based cohort study. Eur J Orthop Surg Traumatol 36, 429 (2026). https://doi.org/10.1007/s00590-026-05016-1

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