title: Outcomes and National Trends for the Surgical Treatment of Lumbar Spine Trauma.
abstract: Introduction. Operative treatment of lumbar spine compression fractures includes fusion and/or cement augmentation. Our aim was to evaluate postoperative differences in patients treated surgically with fusion, vertebroplasty, or kyphoplasty. Methods. The Nationwide Inpatient Sample Database search for adult vertebral compression fracture patients treated 2004-2011 identified 102,316 surgical patients: 30.6% underwent spinal fusion, 17.1% underwent kyphoplasty, and 49.9% underwent vertebroplasty. Univariate analysis of patient and hospital characteristics, by treatment, was performed. Multivariable analysis was used to determine factors associated with mortality, nonroutine discharge, complications, and patient safety. Results. Average patient age: fusion (46.2), kyphoplasty (78.5), vertebroplasty (76.7) (p < .0001). Gender, race, household income, hospital-specific characteristics, and insurance differences were found (p ≤ .001). Leading comorbidities were hypertension, osteoporosis, and diabetes. Risks for higher mortality (OR 2.0: CI: 1.6-2.5), nonroutine discharge (OR 1.6, CI: 1.6-1.7), complications (OR 1.1, CI: 1.0-1.1), and safety related events (OR 1.1, CI: 1.0-1.1) rose consistently with increasing age, particularly among fusion patients. Preexisting comorbidities and longer in-hospital length of stay were associated with increased odds of nonroutine discharge, complications, and patient safety. Conclusions. Fusion patients had higher rates of poorer outcomes compared to vertebroplasty and kyphoplasty cohorts. Mortality, nonroutine discharge, complications, and adverse events increased consistently with older age.
authors.affiliation: Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
authors.forename: Doniel
authors.identifier: 0000-0003-2705-6998
authors.initials: D
authors.lastname: Drazin
authors.affiliation: Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
authors.forename: Miriam
authors.initials: M
authors.lastname: Nuno
authors.affiliation: Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; Department of Surgery, University of Arizona College of Medicine, Tucson, AZ 85724, USA.
authors.forename: Faris
authors.initials: F
authors.lastname: Shweikeh
authors.affiliation: Department of Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA 19107, USA.
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Vaccaro
authors.affiliation: Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
authors.forename: Eli
authors.initials: E
authors.lastname: Baron
authors.affiliation: Department of Orthopedics, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
authors.forename: Terrence T
authors.initials: TT
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; Department of Neurosurgery, University of California Davis Medical Center, Sacramento, CA 95820, USA.
authors.forename: J Patrick
authors.initials: JP
authors.lastname: Johnson
mesh_terms: D000293:Adolescent; D000328:Adult; D016208:Databases, Factual; D005260:Female; D050815:Fractures, Compression / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008161:Lumbosacral Region / Q000293:injuries / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016103:Spinal Fractures / Q000601:surgery*; D013123:Spinal Fusion