Impact of Nonoperative Treatment, Vertebroplasty, and Kyphoplasty on Survival and Morbidity After Vertebral Compression Fracture in the Medicare Population

Chen, Andrew T.; Cohen, David B.; Skolasky, Richard L.

doi:10.2106/jbjs.k.01649

Cited by 123 publications

(116 citation statements)

References 23 publications

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“…Prior reports have demonstrated a mortality benefit favoring vertebroplasty or kyphoplasty vs nonoperative management in elderly individuals with vertebral compression fractures over 3-4 years of follow-up. 9,17 Whether a similar benefit can be observed in the acute inpatient setting as suggested by our data remains to be seen and should be systematically studied. Similarly interesting is the increased odds ratio of death with noninstrumented surgery.…”

Section: Inpatient Mortalitysupporting

confidence: 61%

Perioperative morbidity and mortality after lumbar trauma in the elderly

Winkler¹,

Yue²,

Birk³

et al. 2015

FOC

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OBJECT Traumatic fractures of the thoracolumbar spine are common injuries, accounting for approximately 90% of all spinal trauma. Lumbar spine trauma in the elderly is a growing public health problem with relatively little evidence to guide clinical management. The authors sought to characterize the complications, morbidity, and mortality associated with surgical and nonsurgical management in elderly patients with traumatic fractures of the lumbar spine. METHODS Using the National Sample Program of the National Trauma Data Bank, the authors performed a retrospective analysis of patients ≥ 55 years of age who had traumatic fracture to the lumbar spine. This group was divided into middle-aged (55–69 years) and elderly (≥ 70 years) cohorts. Cohorts were subdivided into nonoperative, vertebroplasty or kyphoplasty, noninstrumented surgery, and instrumented surgery. Univariate and multivariable analyses were used to characterize and identify predictors of medical and surgical complications, mortality, hospital length of stay, ICU length of stay, number of days on ventilator, and hospital discharge in each subgroup. Adjusted odds ratios, mean differences, and associated 95% CIs were reported. Statistical significance was assessed at p < 0.05, and the Bonferroni correction for multiple comparisons was applied for each outcome analysis. RESULTS Between 2003 and 2012, 22,835 people met the inclusion criteria, which represents 94,103 incidents nationally. Analyses revealed a similar medical and surgical complication profile between age groups. The most prevalent medical complications were pneumonia (7.0%), acute respiratory distress syndrome (3.6%), and deep venous thrombosis (3%). Surgical site infections occurred in 6.3% of cases. Instrumented surgery was associated with the highest odds of each complication (p < 0.001). The inpatient mortality rate was 6.8% for all subjects. Multivariable analyses demonstrated that age ≥ 70 years was an independent predictor of mortality (OR 3.16, 95% CI 2.77–3.60), whereas instrumented surgery (multivariable OR 0.38, 95% CI 0.28–0.52) and vertebroplasty or kyphoplasty (OR 0.27, 95% CI 0.17–0.45) were associated with decreased odds of death. In surviving patients, both older age (OR 0.32, 95% CI 0.30–0.34) and instrumented fusion (OR 0.37, 95% CI 0.33–0.41) were associated with decreased odds of discharge to home. CONCLUSIONS The present study confirms that lumbar surgery in the elderly is associated with increased morbidity. In particular, instrumented fusion is associated with periprocedural complications, prolonged hospitalization, and a decreased likelihood of being discharged home. However, fusion surgery is also associated with reduced mortality. Age alone should not be an exclusionary factor in identifying surgical candidates for instrumented lumbar spinal fusion. Future studies are needed to confirm these findings.

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Section: Inpatient Mortalitysupporting

confidence: 61%

Perioperative morbidity and mortality after lumbar trauma in the elderly

Winkler¹,

Yue²,

Birk³

et al. 2015

FOC

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“…5,[10][11][12][13][14][15] These current findings are potentially clinically relevant because prior studies have shown that patients receiving spine augmentation procedures demonstrate improved survival and quality of life compared with patients receiving nonoperative treatment. 16,17 In a study of the 2006 Medicare Provider Analysis and Review File data base, Chen et al 16 demonstrated that patients who underwent vertebroplasty and kyphoplasty had significantly higher 3-year survival rates compared with patients receiving nonoperative management. The Fracture Reduction Evaluation study, which randomized patients into balloon kyphoplasty and nonsurgical management, demonstrated that kyphoplasty was associated with improved quality of life.…”

Section: Discussionmentioning

confidence: 99%

Racial and Health Insurance Disparities of Inpatient Spine Augmentation for Osteoporotic Vertebral Fractures from 2005 to 2010

Gu¹,

Brinjikji²,

El-Sayed

et al. 2014

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Vertebroplasty and kyphoplasty are frequently utilized in the treatment of symptomatic vertebral body fractures. While prior studies have demonstrated disparities in the treatment of back pain and care for osteoporotic patients, disparities in spine augmentation have not been investigated. We investigated racial and health insurance status differences in the use of spine augmentation for the treatment of osteoporotic vertebral fractures in the United States.

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“…10,11 Several large retrospective studies using claims data, investigating vertebroplasty, kyphoplasty and nonsurgical management, provide additional evidence. 12 Two blinded randomized controlled trials failed to demonstrate an advantage in their respective study populations for vertebroplasty over a placebo intervention (sham procedure) for pain reduction or improvement in disability. 13 Following the publication of these results in 2009, the use of VAP in the USA reduced significantly.…”

Section: Effectiveness Of Vertebral Augmentation Proceduresmentioning

confidence: 99%

Controversies on Vertebroplasty and Kyphoplasty for Vertebral Compression Fractures

Teles

Mattei²,

Righesso

et al. 2015

Coluna/Columna

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Vertebroplasty and kyphoplasty are widely used for osteoporotic and cancer-related vertebral compression fractures refractory to medical treatment. Many aspects of these procedures have been extensively discussed in the literature during the last few years. In this article, we perform a critical appraisal of current evidence on effectiveness and ongoing controversies regarding surgical technique, indications and contraindications, clinical outcomes and potential complications of these procedures.

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Impact of Nonoperative Treatment, Vertebroplasty, and Kyphoplasty on Survival and Morbidity After Vertebral Compression Fracture in the Medicare Population

Abstract: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Cited by 123 publications

References 23 publications

Perioperative morbidity and mortality after lumbar trauma in the elderly

Perioperative morbidity and mortality after lumbar trauma in the elderly

Racial and Health Insurance Disparities of Inpatient Spine Augmentation for Osteoporotic Vertebral Fractures from 2005 to 2010

Controversies on Vertebroplasty and Kyphoplasty for Vertebral Compression Fractures

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