When treatment rates for a common hip fracture go up among Medicare beneficiaries, so too does the risk for adverse outcomes, costs and mortality, new research has shown.

Proximal humerus fractures are extremely common in the elderly and are usually the result of a fall. But surgery may not be the best course of action in vulnerable groups, the study suggests. Adults who are older, frail and have more comorbidities are at high risk of complications at one year, reported lead author Sarah B. Floyd, Ph.D., from the University of South Carolina.

“Patients with proximal humerus fractures are an especially frail population, and the surgery decision is associated with a series of events that can trigger poor outcomes, including death,” Floyd and colleagues wrote.

The investigators analyzed data from more than 72,000 fee-for-service Medicare beneficiaries with these fractures. Rates of surgery varied widely, ranging from 1.8% to 33%. Higher rates were linked to higher costs in the year following surgery. Furthermore, each 1% increase in surgery rate was associated with an increase in adverse events and mortality.

Full findings were published in JAMA Network Open.