National trends in vertebral augmentation procedures for the treatment of vertebral compression fractures.
BACKGROUND
Vertebral compression fractures represent a serious health care problem. Vertebroplasty and kyphoplasty have been gaining popularity in the treatment of symptomatic compression fractures that are often secondary to osteoporosis or neoplasia.


METHODS
We use the NIS database from 1993 through 2004 to examine trends in VCFs. Patients with VCFs were identified using primary diagnostic codes (ICD-9-pathologic vertebral fracture, 733.13) and cross-referenced with ICD-9 procedure codes (ICD-9-VAPs, 78.49; kyphoplasty, 81.66; and vertebroplasty, 81.65).


RESULTS
In 2004, more than 23 000 VAPs were performed nationwide on an inpatient basis for VCFs. This represented a 12 900% increase in the number of procedures performed since 1993. Approximately 60% of patients were female and aged 65 to 84 years. Nearly 60% of vertebroplasties and 25% of kyphoplasties were on patients admitted from the ED. Large-sized hospitals and those hospitals located in the southern United States accounted for most of the cases. The mean LOS was 3.7 days for kyphoplasty and 7.3 days for vertebroplasty. The final discharge disposition, home vs institution (nursing home, rehabilitation), was 50:50 for vertebroplasty and 77:23 for kyphoplasty. The mean hospital charges for both procedures were comparable, and the total "national bill" was approximately $672 million in 2004.


CONCLUSIONS
With the continued aging of the population, VCFs represent an increasingly important health care issue. The staggering increase in the number of minimally invasive VAPs performed illustrates the continued adoption of these innovative technologies and early trends in their applications.
Lad
Shivanand P
SP
Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA.
Patil
Chirag G
CG
Lad
Eleonora M
EM
Hayden
Melanie G
MG
Boakye
Maxwell
M
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D005260:Female; D005568:Forms and Records Control; D050815:Fractures, Compression / Q000601:surgery*; D017048:Health Care Costs / Q000706:statistics & numerical data; D006761:Hospitals / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D007902:Length of Stay; D008134:Long-Term Care / Q000706:statistics & numerical data / Q000639:trends; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends; D017678:Sex Distribution; D016103:Spinal Fractures / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D013131:Spine / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D014481:United States; D054854:Vertebroplasty / Q000191:economics / Q000706:statistics & numerical data* / Q000639:trends*; D055815:Young Adult