Introduction: Treatment of lumbar spine fractures has included surgical fusion with instrumentation and cement augmentation (kyphoplasty, vertebroplasty). To analyze national trends, we studied population demographics, treatment patterns, outcomes and complications.
Methods: Searching Nationwide Inpatient Sample database using ICD-9-CM codes, we identified adults treated 2004-2009 with primary diagnosis of lumbar fracture who underwent: fusion, kyphoplasty or vertebroplasty. Demographics and hospital characteristics were analyzed. Mortality, hospitalization length, safety indicators and complications were calculated as outcomes. Logistic regression correlated demographic risk factors with outcomes.
Results: 75,384 surgical patients: fusion (28.7%), kyphoplasty (17.0%), vertebroplasty (51.8%), multiple surgeries (2.5%). Year-over-year, fusions decreased 7.4% and augmentation increased >450%. Fusion patients were significantly younger (<44 vs >65,p<0.001) with >3 comorbidities (20.6% vs. 50.6%,p<0.0001). Mortality rates: fusion (0.7%), kyphoplasty (0.6%), vertebroplasty (0.3%) (p<0.001). Complication rates: fusion (23.0%), kyphoplasty (19.9%), vertebroplasty (14.3%). Augmentation complications significantly increased (13.5-20.1%, p<.0001). Hospitalization days: fusion (10.1), kyphoplasty (5.9), vertebroplasty (4.4). Consistently increasing trends (mortality, non-routine discharge) were observed with older age. Fusion patients had significantly higher safety indicators and complications, independent of age (13.9% vs. 6.1%,p<0.001). Age had significant increments for 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 complications: 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), kyphoplasty (OR 1.2, 95%CI:1.0-1.4), fusion (OR 2.5, 95%CI:2.1-3.0).
Conclusions: Fusion had the highest adverse outcomes and longest hospital stays. Previously considered low risk, augmentation complication rates rose year-to-year and kyphoplasty had mortality rates comparable to fusion. Age and medical comorbidities were independent risk factors for poor outcomes (all intervention types). A national trend favoring cement augmentation over fusion showed a dramatic (450%) increase.
Patient Care: Lumbar spine fractures are common and surgeons need objective data to consider in deciding on which surgical intervention (fusion, kyphoplasty or vertebroplasty) will best serve their patient. By knowing the complication rates and outcomes from a large study (75,384 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 fusion and 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 fusion, 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.