title: Morbidity, mortality, and readmission after vertebral augmentation: analysis of 850 patients from the American College of Surgeons National Surgical Quality Improvement Program database.
abstract: METHODS
  Retrospective cohort study.
  
  
  OBJECTIVE
  To identify risk factors for poor short-term outcomes after vertebral augmentation procedures.
  
  
  BACKGROUND
  Vertebral compression fractures are the most common fractures of osteoporosis and are frequently treated with vertebroplasty or kyphoplasty. There is a shortage of information about risk factors for short-term, general health outcomes after vertebral augmentation in the literature.
  
  
  METHODS
  Patients older than 65 years who underwent vertebroplasty or kyphoplasty in 2011 and 2012 were identified from the American College of Surgeons National Surgical Quality Improvement Program database. Patient characteristics were tested for association with 30-day adverse events, mortality, and readmission using bivariate and multivariate analyses.
  
  
  RESULTS
  A total of 850 patients met inclusion criteria. The average age was 78.9±11.7 years (mean±standard deviation) and females made up 70.8% of the cohort. Of these patients, 9.5% had any adverse event (AAE), and 6.6% had a serious adverse event (SAE). Death occurred in 1.5% of patients, and 10.8% were readmitted within the first 30 postoperative days.On multivariate analysis, AAE and SAE were both significantly associated with American Society of Anesthesiologists class 4 (AAE: odds ratio [OR]=2.7, P=0.013; SAE: OR=2.5, P=0.040) and inpatient status before procedure (AAE: OR=2.7, P<0.001, SAE: OR=2.4, P=0.003). Increased postoperative mortality rate was associated with American Society of Anesthesiologists class 4 (OR=6.4, P=0.024) and the use of nongeneral anesthesia (OR=4.0, P=0.022). Readmission was associated with history of pulmonary disease (OR=2.0, P=0.005) and inpatient status before procedure (OR=1.9, P=0.005).
  
  
  CONCLUSIONS
  Adverse general health outcomes were relatively common, and the factors identified in the earlier text associated with patient outcomes after vertebral augmentation may be useful for preoperative discussions and counseling.
  
  
  METHODS
  3.
authors.affiliation: From the Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT.
authors.forename: Jason O
authors.initials: JO
authors.lastname: Toy
authors.forename: Bryce A
authors.initials: BA
authors.lastname: Basques
authors.forename: Jonathan N
authors.initials: JN
authors.lastname: Grauer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual / Q000592:standards / Q000639:trends*; D005260:Female; D050815:Fractures, Compression / Q000401:mortality* / Q000601:surgery; D006801:Humans; D058498:Kyphoplasty / Q000401:mortality / Q000639:trends; D008297:Male; D009017:Morbidity; D009026:Mortality / Q000639:trends; D010359:Patient Readmission / Q000592:standards / Q000639:trends*; D011446:Prospective Studies; D058996:Quality Improvement / Q000592:standards / Q000639:trends*; D016103:Spinal Fractures / Q000401:mortality* / Q000601:surgery; D014481:United States / Q000453:epidemiology; D054854:Vertebroplasty / Q000401:mortality* / Q000639:trends