title: Kyphoplasty and vertebroplasty: trends in use in ambulatory and inpatient settings.
abstract: BACKGROUND
  Vertebral compression fractures (VCFs) are a substantial health concern. Kyphoplasty (KP) and vertebroplasty (VP) are vertebral augmentation procedures (VAPs) used to treat VCFs.
  
  
  OBJECTIVE
  To compare VP and KP patient demographics and evaluate inpatient and outpatient utilization trends.
  
  
  METHODS
  Retrospective analysis of patient demographics, and inpatient and outpatient utilization trends, from California, New York, and Florida inpatient and ambulatory discharge databases.
  
  
  METHODS
  Hospitalizations for VP and KP were identified from California, New York, and Florida inpatient and ambulatory discharge databases from 2005 to 2008. International Classification of Diseases, Ninth Revision diagnosis codes for pathologic, dorsal, and lumbar fracture of vertebrae were cross-referenced with ICD-9 procedure codes and Current Procedural Terminology codes to select the population. Patients younger than 40 years or those who underwent both procedures were excluded.
  
  
  RESULTS
  The final population contained 61,851 VAPs (35,805 KPs and 26,046 VPs). Kyphoplasty showed increased inpatient and outpatient utilization. Vertebroplasty utilization remained at a low level of 6/100,000 capita. Kyphoplasty patients had more comorbidities than VP patients. In Florida in 2008, radiologists performed most VPs (52.3%) and orthopedists performed the most KPs (35.45%). Postoperative complication rates were significantly different; 0.79% of KPs had cardiac complications versus 0.57% of VPs (p=.0073). Respiratory complications occurred in 0.83% of KPs and 0.49% of VPs (p<.0001).
  
  
  CONCLUSIONS
  Vertebral augmentation procedures have seen a continued increase in use from 2004 to 2008. Use of KP significantly outpaces the use of VP. Reasons for the increasing utilization of KP likely include financial incentives, the specialty performing KP, perceived safety, and effectiveness of vertebral height restoration. Conflicting evidence regarding which procedure is safer warrants further evaluation.
authors.affiliation: Leni and Peter W. May Department of Orthopaedic Surgery, The Mount Sinai Medical Center, 5 East 98th St, 9th Floor, New York, NY 10029, USA.
authors.forename: Vadim
authors.initials: V
authors.lastname: Goz
authors.forename: Steven M
authors.initials: SM
authors.lastname: Koehler
authors.forename: Natalia N
authors.initials: NN
authors.lastname: Egorova
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Moskowitz
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Guillerme
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Hecht
authors.forename: Sheeraz A
authors.initials: SA
authors.lastname: Qureshi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D058498:Kyphoplasty / Q000009:adverse effects / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010045:Outpatients / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000453:epidemiology / Q000601:surgery*; D054854:Vertebroplasty / Q000009:adverse effects / Q000706:statistics & numerical data*