Comparison of 5766 Vertebral Compression Fractures Treated With or Without Kyphoplasty

Abstract

Background The majority of the 700,000 osteoporotic vertebral compression fractures (VCFs) that occur annually in the United States affect women. The total treatment costs exceed $17 billion and approximate the total costs of breast cancer ($13 billion) and heart disease ($19 billion). Balloon-assisted percutaneous vertebral augmentation with bone cement (kyphoplasty) reportedly reduces VCF-related pain and accelerates return of independent functional mobility. Kyphoplasty may decrease overall cost of VCF treatment costs by reducing use of posttreatment medical resources. Questions/purposes We evaluated complications, mortality, posthospital disposition, and treatment costs of kyphoplasty compared with nonoperative treatment using the Nationwide Inpatient Sample database.Methods We identified 5766 VCFs (71% female) in patients 65 years of age or older with nonneoplastic VCF as the primary diagnosis in nonroutine hospital admissions; 15.3% underwent kyphoplasty. Demographic data, medical comorbidities, and fracture treatment type were recorded. Outcomes, including complications, mortality, posthospital disposition, and treatment costs, were compared for each treatment type. Results Women were more likely to be treated with kyphoplasty than were men. Patients undergoing kyphoplasty had comorbidity indices equivalent to those treated nonoperatively. Kyphoplasty was associated with a greater likelihood of routine discharge to home (38.4% versus 21.0% for nonoperative treatment), a lower rate of discharge to skilled nursing (26.1% versus 34.8%) or other facilities (35.7% versus 47.1%), a complication rate equivalent to nonoperative treatment (1.7% versus 1.0%), and a lower rate of in-hospital mortality (0.3% versus 1.6%). Kyphoplasty was associated with higher cost of hospitalization (mean $37,231 versus $20,112).

Safety and Efficacy of Balloon Kyphoplasty for Compression Fractures in the Very Elderly

“…Osteoporosis affects greater than 55% of women older than age 55 and is characterized by decreased bone mineral density resulting in increased bone fragility and a higher susceptibility to fracture [11]. In the United States, osteoporosis leads to over 700,000 vertebral compression fractures per year.…”

“…The initial treatment of VCF includes activity modification and analgesic medications [11]. Many patients sustain serious cardiovascular, musculoskeletal, metabolic, and immune complications related to immobility and bed rest [18].…”

“…Elderly patients typically affected by VCF often cannot tolerate the complications of non-operative care. These elderly patients can be admitted to a hospital for treatment, discharged, and readmitted to treat complications with medical resources used at each stage [11,19]. The result can be a downward spiral of complications, functional decline, and a higher risk of death as a result of the VCF for this fragile subgroup of patients [3,[20][21][22].…”

“…Treatment of VCF in the very elderly that accelerates the return of patient function can potentially reduce both the medial risks as well as the economic burden of the disease [11]. It is for this reason that there has been such an interest in the adoption and evaluation of percutaneous vertebral augmentation for the management of VCF.…”

“…There is currently a substantial body of literature supporting the use of percutaneous balloon kyphoplasty for the treatment of symptomatic compression fractures [5][6][7][8][9][10][11]. The procedure is minimally invasive, and it can frequently be performed in an outpatient setting.…”