Comparison of 5766 vertebral compression fractures treated with or without kyphoplasty.
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.


OBJECTIVE
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).


CONCLUSIONS
Kyphoplasty for treatment of VCF in well-selected patients may accelerate the return of independent patient function as indicated by improved measures of hospital discharge. The initially higher cost of treatment may be offset by the reduced use of posthospital medical resources.


METHODS
Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Zampini
Jay M
JM
Department of Orthopaedic Surgery, Hahnemann University Hospital, Drexel University College of Medicine, 245 N 15th Street, Philadelphia, PA, 19102, USA. jay.zampini@tenethealth.com
White
Andrew P
AP
McGuire
Kevin J
KJ
D000368:Aged; D000369:Aged, 80 and over; D001843:Bone Cements; D002484:Cementation; D016208:Databases, Factual; D005260:Female; D050815:Fractures, Compression / Q000209:etiology / Q000534:rehabilitation / Q000601:surgery*; D017048:Health Care Costs; D006801:Humans; D007902:Length of Stay; D008297:Male; D010024:Osteoporosis / Q000150:complications; D011183:Postoperative Complications; D020127:Recovery of Function; D012737:Sex Factors; D016103:Spinal Fractures / Q000209:etiology / Q000534:rehabilitation / Q000601:surgery*; D016896:Treatment Outcome; D054854:Vertebroplasty / Q000191:economics / Q000379:methods*
D001843:Bone Cements