Operative vs non-operative management of displaced proximal humeral fractures in the elderly: A systematic review and meta-analysis of randomized controlled trials

Table 3 Grading of Recommendations Assessment, Development, and Evaluation summary findings: Operative vs non-operative treatment in proximal humeral fractures

Outcomes	No. of Participants(studies)	Quality of the evidence (GRADE)	Relative effect(95%CI)	Anticipated absolute effects
	Follow up				Risk difference between non-operative and operative1 (95%CI)
Physical Function by Constant score - long term	229 (5 studies)	Moderate due to risk of bias			The mean physical function by constant score-long term in the intervention group was 1.63 higher (2.84 lower to 6.11 higher)
Health Related Quality of Life - long term	154 (3 studies)	Moderate due to risk of bias			The mean health related quality of life - long term in the intervention group was 0.23 standard deviations higher (0.09 lower to 0.54 higher)
Constant pain - long term	229 (5 studies)	Low due to risk of bias, inconsistency			The mean Constant pain - long term in the intervention group was 0.28 higher (1.01 lower to 1.57 higher)
Mortality rate	247 (5 studies)	Moderate due to risk of bias	RR 1.14 (0.45 to 2.86)	Study population
				56 per 1000	8 more per 1000 (from 31 fewer to 105 more)
				Moderate
				63 per 1000	9 more per 1000 (from 35 fewer to 117 more)
Re-operation Rate	247 (5 studies)	Low due to risk of bias, imprecision	RR 3.62 (1.38 to 9.49)	Study population
				32 per 1000	85 more per 1000 (from 12 more to 274 more)
				Moderate
				36 per 1000	94 more per 1000 (from 14 more to 306 more)

¹The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95%CI). RR: Risk ratio; GRADE Working Group grades of evidence: High quality: Further research is very unlikely to change our confidence in the estimate of effect; Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate; Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate; Very low quality: We are very uncertain about the estimate.