title: Percutaneous vertebroplasty and kyphoplasty for pathologic vertebral fractures in the Medicare population: safer and less expensive than open surgery.
abstract: OBJECTIVE
  To compare cost and outcomes of surgical and percutaneous treatments of pathologic vertebral fractures.
  
  
  METHODS
  Standard Medicare 5% anonymized inpatient files (1999-2009) were retrospectively reviewed. Patients with a diagnosis of vertebral fracture without spinal cord injury and primary or metastatic bony malignancy were divided into percutaneous or surgical groups based on whether they received vertebroplasty/kyphoplasty or surgical treatment. Patients who had no intervention or both interventions were excluded. Cost, length of stay, and type of discharge were examined while controlling for demographic and comorbidity variables.
  
  
  RESULTS
  A total of 451 patients were included; 52% received percutaneous treatment and 48% received surgery. Patients treated percutaneously were older (P < .001) and more likely to be female (P = .04). Percutaneous therapy predicted $14,862 less Medicare cost and $13,565 less overall cost (P < .001 for both), and 4.1 fewer inpatient days (P < .001). Patients who underwent surgery had higher odds of death (odds ratio = 3.38, P = .016), discharge to a rehabilitation facility (odds ratio = 3.3, P = .003), and transfer to another inpatient facility (odds ratio = 8.53, P < .001), and lower odds of discharge to home (odds ratio = 0.42, P < .001) and hospice (odds ratio = 0.08, P = .002).
  
  
  CONCLUSIONS
  In a Medicare population with bony malignancy and vertebral fractures, percutaneous therapy predicted significantly reduced cost and length of stay versus surgery. Patients who underwent percutaneous therapy were significantly less likely to die, be transferred, or be discharged to rehabilitation facilities, and were more likely to be discharged to home or hospice.
authors.affiliation: Department of Imaging, The Queen's Medical Center, Honolulu, HI 96813, USA. mitagakimd@gmail.com
authors.forename: Michael W
authors.initials: MW
authors.lastname: Itagaki
authors.forename: Adam D
authors.initials: AD
authors.lastname: Talenfeld
authors.forename: Sharon W
authors.initials: SW
authors.lastname: Kwan
authors.forename: Julian W M
authors.initials: JW
authors.lastname: Brunner
authors.forename: Kelly E
authors.initials: KE
authors.lastname: Mortell
authors.forename: Michael C
authors.initials: MC
authors.lastname: Brunner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000150:complications / Q000191:economics / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D016009:Chi-Square Distribution; D015897:Comorbidity; D005260:Female; D005598:Fractures, Spontaneous / Q000191:economics / Q000209:etiology / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D017048:Health Care Costs; D017051:Hospice Care; D006738:Hospices; D006801:Humans; D058498:Kyphoplasty / Q000009:adverse effects / Q000191:economics / Q000401:mortality; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D006278:Medicare / Q000191:economics; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010351:Patient Discharge; D010360:Patient Transfer; D012047:Rehabilitation Centers; D012189:Retrospective Studies; D012307:Risk Factors; D016103:Spinal Fractures / Q000191:economics / Q000209:etiology / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D013123:Spinal Fusion / Q000009:adverse effects / Q000191:economics / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D054854:Vertebroplasty / Q000009:adverse effects / Q000191:economics / Q000379:methods* / Q000401:mortality