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  • Vertebral augmentation and the elderly - a benign solution? National evidence of the impact of age and comorbidities on complications, discharge disposition and mortality.

    Final Number:

    Doniel Drazin MD MA; Miriam Nuno PhD; Faris Shweikeh BS; J. Patrick Johnson, MD MD; Terrence T. Kim MD; Alexander R. Vaccaro MD; Eli M. Baron MD

    Study Design:
    Laboratory Investigation

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2014 Annual Meeting

    Introduction: Lumbar spine fractures secondary to trauma are common. We analyzed population demographics, treatment patterns, outcomes and complications for patients undergoing two types of vertebral augmentation: kyphoplasty and vertebroplasty.

    Methods: Searching the Nationwide Inpatient Sample database using ICD-9-CM codes, we identified adults treated 2004-2009 with primary diagnosis of lumbar fracture who underwent kyphoplasty or vertebroplasty. Demographics and hospital characteristics were documented and analyzed. Mortality, hospitalization length, safety indicators and complications were calculated as outcomes. Logistic regression correlated demographic risk factors with outcomes.

    Results: Of 51,891 surgical patients identified, 12,839 (24.7%) were kyphoplasty and 39,052 (75.3%) were vertebroplasty. Complication rates: kyphoplasty (19.9%) vs. vertebroplasty (14.3%) (p<0.05). Hospitalization days: kyphoplasty (5.9) vs. vertebroplasty (4.4) (p<0.05). Kyphoplasty had more non-routine discharges. Mortality was slightly higher with kyphoplasty (0.6%) than vertebroplasty (0.3%) (p<0.001). Median charges were higher for vertebroplasty ($31,974) than for kyphoplasty ($24,983). Over time, cement augmentation procedures increased in frequency. Consistently increasing trends in mortality and non-routine discharge were observed with older age. Age had a significant increment in odds of mortality (OR 2.2, 95% CI:1.6-2.9). Factors correlating with higher non-routine discharges: older age (OR 1.5, 95% CI:1.5-1.7), females (OR 1.2, 95% CI:1.1-1.3), increased comorbidities (OR 1.3, 95% CI:1.2-3.5). Factors associated with increased risk of complication: older age (OR 1.1, 95% CI:1.0-1.1), white (OR 1.2, 95% CI:1.0-1.5), increased comorbidities (OR 1.7, 95% CI:1.6-1.7), and kyphoplasty (OR 1.2, 95% CI:1.0-1.4).

    Conclusions: Despite cement augmentation for lumbar fracture being considered a relatively benign procedure, our study found that age and medical comorbidities are significant and independent risk factors for poor outcomes, regardless of intervention type. Compared to vertebroplasty, kyphoplasty was associated with longer hospitalizations, higher rates of complications and more non-routine discharges while vertebroplasty had higher costs.

    Patient Care: Lumbar spine fractures are common and surgeons need objective data to consider in deciding on which surgical intervention (kyphoplasty or vertebroplasty) will best serve their patient. By knowing the complication rates and outcomes from a large study (> 50,000 surgical patients), surgeons can consider their patient’s risk factors in deciding treatment recommendations. By sharing these statistics for potential complications with their patient in pre-treatment counseling, surgeons can help the patient reach a more informed treatment decision.

    Learning Objectives: 1. Surgeons will better understand the trends and patterns in patient care concerning vertebral augmentation (kyphoplasty, vertebroplasty) for treatment of lumbar spine compression fractures. 2. Providers will be presented with data regarding the risk factors and outcomes (mortality, hospitalization length, safety indicators, complications) associated with kyphoplasty and vertebroplasty based upon analysis from a large retrospective database study. 3. Surgeons will have relevant demographic and risk factor information to aid in making a surgical treatment recommendation and for use in pre-surgical patient counseling.


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