RESUMEN

To investigate the relationship between preoperative blood glucose levels and long-term all-cause mortality in patients with osteoporotic vertebral compression fractures (OVCF) who underwent percutaneous vertebroplasty (VP). This single-center retrospective study involved a chart review of patients admitted for VP to treat OVCF between 2013 and 2020. Patients with pathological or multiple fractures or those who did not undergo bone mineral density assessment were excluded. All relevant information was collected from electronic medical records. The survival status of all patients was confirmed at the end of March 2021. Cox proportional hazard models with multivariate adjustments were used to examine the effects of blood glucose levels on all-cause mortality. Overall, 131 patients were retrospectively analyzed (mean age: 75.8 ± 9.3 years, male patients: 26.7%) with a median follow-up period of 2.1 years. Preoperative hyperglycemia (hazard ratio: 2.668, 95% confidence interval [CI] 1.064, 6.689; p = 0.036) and glucose levels (hazard ratio: 1.007, 95% CI 1.002-1.012; p = 0.006) were found to be independently associated with a higher risk of all-cause mortality. This correlation remained significant even after adjusting for age and sex, and other factors and comorbidities that might affect outcomes (hazard ratio: 2.708, 95% CI 1.047, 7.003, p = 0.040 and 1.007; 95% CI 1.001, 1.013, p = 0.016, respectively). Furthermore, a history of diabetes mellitus was not a significant factor influencing long-term all-cause mortality. Preoperative glucose levels were found to be independently associated with survival outcomes in patients with OVCF who underwent VP. Conversely, diabetes mellitus was not associated with long-term all-cause mortality. Our findings highlight that preoperative hyperglycemia is a risk factor for long-term mortality in this aging surgical population.

Asunto(s)

Glucemia , Fracturas por Compresión , Fracturas Osteoporóticas , Fracturas de la Columna Vertebral , Vertebroplastia , Humanos , Masculino , Anciano , Femenino , Fracturas por Compresión/cirugía , Fracturas por Compresión/mortalidad , Fracturas Osteoporóticas/cirugía , Fracturas Osteoporóticas/mortalidad , Fracturas de la Columna Vertebral/mortalidad , Fracturas de la Columna Vertebral/cirugía , Fracturas de la Columna Vertebral/etiología , Glucemia/análisis , Glucemia/metabolismo , Estudios Retrospectivos , Anciano de 80 o más Años , Periodo Preoperatorio , Factores de Riesgo , Modelos de Riesgos Proporcionales , Hiperglucemia/mortalidad , Hiperglucemia/complicaciones , Hiperglucemia/etiología

RESUMEN

OBJECTIVE: The aim to evaluate central sarcopenia, as measured by psoas cross-sectional area on admission imaging, is associated with outcomes in patients with vertebral compression fractures (VCFs) treated with percutaneous vertebral augmentation treatment. METHODS: We evaluated the records of patients aged >60 years treated with vertebroplasty or kyphoplasty between 2009 and 2018 for osteoporotic VCFs. The Social Security Death Index was used to determine death. We used the psoas:lumbar vertebral index (PLVI), calculated using the cross-sectional area of the L4 vertebral body and the left and right psoas muscles, to assess for sarcopenia. A multivariate Cox algorithm was applied to recognize factors independently associated with survival. RESULTS: A total of 103 patients were included with an average age of 72.3 years. During the study period, 22 (21.4%) patients were deceased, whereas 81 (78.6%) were alive. The survival rates at 1 month, 6 months, and 1 year after surgery were 99%, 94.1%, and 88.4%, respectively. PLVI measurements ranged from 0.24-1.19 with a mean of 0.59 ± 0.17 and a median of 0.603. A total of 51 patients with a median value of 0.603 were defined as low PLVI group, and 52 patients with a median value of ≥0.603 were defined as the high PLVI group. PLVI was significantly low in patients who died. Age, American Society of Anesthesiologists score, and PLVI value were independently associated with a poor overall survival. CONCLUSIONS: There is a significant correlation between sarcopenia and postoperative mortality after vertebral augmentation procedure in patients with VCFs.

Asunto(s)

Fracturas Osteoporóticas/complicaciones , Fracturas Osteoporóticas/cirugía , Sarcopenia/complicaciones , Fracturas de la Columna Vertebral/complicaciones , Fracturas de la Columna Vertebral/cirugía , Anciano , Anciano de 80 o más Años , Femenino , Fracturas por Compresión/complicaciones , Fracturas por Compresión/mortalidad , Fracturas por Compresión/cirugía , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Fracturas Osteoporóticas/mortalidad , Estudios Retrospectivos , Factores de Riesgo , Fracturas de la Columna Vertebral/mortalidad , Resultado del Tratamiento , Vertebroplastia/métodos

RESUMEN

Background Osteoporotic vertebral compression fractures (OVCFs) are prevalent, with associated morbidity and mortality. Vertebral augmentation (VA), defined as either vertebroplasty and/or balloon kyphoplasty (BKP), is a minimally invasive surgical treatment to reduce pain and further collapse and/or renew vertebral body height by introducing bone cement into fractured vertebrae. Nonsurgical management (NSM) for OVCF carries inherent risks. Purpose To summarize the literature and perform a meta-analysis on the mortality outcomes of patients with OVCF treated with VA compared with those in patients treated with NSM. Materials and Methods A single researcher performed a systematic literature review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, or PRISMA, guidelines. Online scientific databases were searched in April 2018 for English-language publications. Included studies investigated mortality in patients with OVCF with VA as the primary intervention and NSM as the comparator. A meta-analysis was performed for studies that reported hazard ratios (HRs) and 95% confidence intervals (CIs). HR was used as a summary statistic and was random-effect-models tested. The χ2 test was used to study heterogeneity between trials, and the I2 statistic was calculated to estimate variation across studies. Results Of the 16 included studies, eight reported mortality benefits in VA, seven reported no mortality difference, and one reported mixed results. Seven studies were included in a meta-analysis examining findings in more than 2 million patients with OVCF (VA = 382 070, NSM = 1 707 874). The pooled HR comparing VA to NSM was 0.78 (95% CI: 0.66, 0.92; P = .003), with mortality benefits across 2- and 5-year periods (HR = 0.70, 95% CI: 0.69, 0.71, P < .001; and HR = 0.79, 95% CI: 0.62, 0.9999, P = .05; respectively). Balloon kyphoplasty provided mortality benefits over vertebroplasty, with HRs of 0.77 (95% CI: 0.77, 0.78; P < .001) and 0.87 (95% CI: 0.87, 0.88; P < .001), respectively. Conclusion In a meta-analysis of more than 2 million patients, those with osteoporotic vertebral compression fractures who underwent vertebral augmentation were 22% less likely to die at up to 10 years after treatment than those who received nonsurgical treatment. © RSNA, 2020 See also the editorial by Jennings in this issue.

Asunto(s)

Fracturas por Compresión/mortalidad , Fracturas por Compresión/cirugía , Fracturas Osteoporóticas/mortalidad , Fracturas Osteoporóticas/cirugía , Fracturas de la Columna Vertebral/mortalidad , Fracturas de la Columna Vertebral/cirugía , Vertebroplastia , Humanos , Cifoplastia

RESUMEN

The 5-year period following 2009 saw a steep reduction in vertebral augmentation volume and was associated with elevated mortality risk in vertebral compression fracture (VCF) patients. The risk of mortality following a VCF diagnosis was 85.1% at 10 years and was found to be lower for balloon kyphoplasty (BKP) and vertebroplasty (VP) patients. INTRODUCTION: BKP and VP are associated with lower mortality risks than non-surgical management (NSM) of VCF. VP versus sham trials published in 2009 sparked controversy over its effectiveness, leading to diminished referral volumes. We hypothesized that lower BKP/VP utilization would lead to a greater mortality risk for VCF patients. METHODS: BKP/VP utilization was evaluated for VCF patients in the 100% US Medicare data set (2005-2014). Survival and morbidity were analyzed by the Kaplan-Meier method and compared between NSM, BKP, and VP using Cox regression with adjustment by propensity score and various factors. RESULTS: The cohort included 261,756 BKP (12.6%) and 117,232 VP (5.6%) patients, comprising 20% of the VCF patient population in 2005, peaking at 24% in 2007-2008, and declining to 14% in 2014. The propensity-adjusted mortality risk for VCF patients was 4% (95% CI, 3-4%; p < 0.001) greater in 2010-2014 versus 2005-2009. The 10-year risk of mortality for the overall cohort was 85.1%. BKP and VP cohorts had a 19% (95% CI, 19-19%; p < 0.001) and 7% (95% CI, 7-8%; p < 0.001) lower propensity-adjusted 10-year mortality risk than the NSM cohort, respectively. The BKP cohort had a 13% (95% CI, 12-13%; p < 0.001) lower propensity-adjusted 10-year mortality risk than the VP cohort. CONCLUSIONS: Changes in treatment patterns following the 2009 VP publications led to fewer augmentation procedures. In turn, the 5-year period following 2009 was associated with elevated mortality risk in VCF patients. This provides insight into the implications of treatment pattern changes and associated mortality risks.

Asunto(s)

Fracturas por Compresión/mortalidad , Fracturas Osteoporóticas/mortalidad , Fracturas de la Columna Vertebral/mortalidad , Vertebroplastia/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Actitud del Personal de Salud , Comorbilidad , Femenino , Fracturas por Compresión/cirugía , Humanos , Estimación de Kaplan-Meier , Cifoplastia/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Masculino , Medicare/estadística & datos numéricos , Mortalidad/tendencias , Fracturas Osteoporóticas/cirugía , Ensayos Clínicos Controlados Aleatorios como Asunto/normas , Proyectos de Investigación/normas , Medición de Riesgo/métodos , Fracturas de la Columna Vertebral/cirugía , Estados Unidos/epidemiología

RESUMEN

BACKGROUND: Vertebral compression fractures (VCF) are common in COPD patients, with osteoporosis being the main cause. The clinical impact of VCF derives mostly from both pain and chest deformity, which may lead to ventilatory and physical activity limitations. Surprisingly, the consequences of VCF on the quality outcomes of hospital care are poorly known. OBJECTIVE: To assess these indicators in patients hospitalized due to a COPD exacerbation (ECOPD) who also have VCF. METHODS: Clinical characteristics and quality care indicators were assessed in two one-year periods, one retrospective (exploratory) and one prospective (validation), in all consecutive patients hospitalized for ECOPD. Diagnosis of VCF was based on the reduction of >20% height of the vertebral body evaluated in standard lateral chest X-ray (three independent observers). RESULTS: From the 248 patients admitted during the exploratory phase, a third had at least one VCF. Underdiagnosis rate was 97.6%, and patients with VCF had more admissions (normalized for survival), longer hospital stays, and higher mortality than patients without (4 [25th-75th percentiles, 2-8] vs 3 [1-6] admissions, P<0.01; 12 [6-30] vs 9 [6-18] days, P<0.05; and 50 vs 32.1% deaths, P<0.01, respectively). The risk of dying in the two following years was also higher in VCF patients (odds ratio: 2.11 [1.2-3.6], P<0.01). The validation cohort consisted of 250 patients who showed very similar results. The logistic regression analysis indicated that both VCF and age were factors independently associated with mortality. CONCLUSION: Although VCF is frequently underdiagnosed in patients hospitalized for ECOPD, it is strongly associated with a worse prognosis and quality care outcomes.

Asunto(s)

Fracturas por Compresión/mortalidad , Admisión del Paciente , Enfermedad Pulmonar Obstructiva Crónica/mortalidad , Fracturas de la Columna Vertebral/mortalidad , Anciano , Anciano de 80 o más Años , Femenino , Fracturas por Compresión/diagnóstico por imagen , Fracturas por Compresión/terapia , Humanos , Estimación de Kaplan-Meier , Tiempo de Internación , Modelos Logísticos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Pronóstico , Estudios Prospectivos , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/terapia , Indicadores de Calidad de la Atención de Salud , Estudios Retrospectivos , Factores de Riesgo , Fracturas de la Columna Vertebral/diagnóstico por imagen , Fracturas de la Columna Vertebral/terapia , Factores de Tiempo

RESUMEN

STUDY DESIGN: Vertebral compression fracture (VCF) patients in the 100% US Medicare data set (2005-2009). OBJECTIVE: To compare the mortality and morbidity risks for VCF patients undergoing conservative treatment (nonoperated), balloon kyphoplasty (BKP), and vertebroplasty (VP). SUMMARY OF BACKGROUND DATA: Studies have reported lower mortality risk for BKP or VP cohorts than nonoperated cohorts, but it is uncertain whether there are any differences in morbidity risks. METHODS: Survival and morbidity was estimated by the Kaplan-Meier method, and the differences in outcomes were assessed by Cox regression between BKP, VP, and nonoperated cohorts. A propensity matching analysis was used to account for potential bias. RESULTS: A total of 1,038,956 VCF patients were identified, including 141,343 BKP patients and 75,364 VP patients. The nonoperated cohort was found to have a 55% higher adjusted risk of mortality (P < 0.001) than the BKP cohort and 25% higher adjusted risk of mortality (P < 0.001) than the VP cohort. The BKP cohort was also found to have a 19% lower adjusted risk of mortality (P < 0.001) than the VP cohort. The findings were similar for mortality with pneumonia diagnosed in the 90 days before death and also after propensity matching, as well as for subgroups of osteoporotic VCF patients, including those who survived at least 1 year and those with no cancer diagnosis. With propensity matching, the nonoperated cohort had significantly higher adjusted risks of pneumonia, myocardial infarction/cardiac complications, DVT, and urinary tract infection than the BKP cohort but lower adjusted risks of subsequent augmentation/fusion, subsequent augmentation, and pulmonary/respiratory complications. The BKP cohort also had significantly lower risks of morbidity than the VP cohort, except for deep venous thrombosis (DVT), infection, and myocardial infarction/cardiac complications, which were similar between both cohorts. CONCLUSION: VCF patients in the Medicare population who received vertebral augmentation therapies, specifically BKP and VP, experienced lower mortality and overall morbidity than VCF patients who received conservative management. LEVEL OF EVIDENCE: 3.

Asunto(s)

Fracturas por Compresión/mortalidad , Fracturas por Compresión/terapia , Cifoplastia/estadística & datos numéricos , Fracturas de la Columna Vertebral/mortalidad , Fracturas de la Columna Vertebral/terapia , Anciano , Fracturas por Compresión/complicaciones , Humanos , Estimación de Kaplan-Meier , Cifoplastia/efectos adversos , Medicare/estadística & datos numéricos , Infarto del Miocardio/epidemiología , Neumonía/epidemiología , Modelos de Riesgos Proporcionales , Fracturas de la Columna Vertebral/complicaciones , Tasa de Supervivencia , Estados Unidos/epidemiología , Infecciones Urinarias/epidemiología , Trombosis de la Vena/epidemiología

RESUMEN

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To identify risk factors for poor short-term outcomes after vertebral augmentation procedures. SUMMARY OF BACKGROUND DATA: 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). CONCLUSION: 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. LEVEL OF EVIDENCE: 3.

Asunto(s)

Bases de Datos Factuales/tendencias , Fracturas por Compresión/mortalidad , Readmisión del Paciente/tendencias , Mejoramiento de la Calidad/tendencias , Fracturas de la Columna Vertebral/mortalidad , Vertebroplastia/mortalidad , Anciano , Anciano de 80 o más Años , Bases de Datos Factuales/normas , Femenino , Fracturas por Compresión/cirugía , Humanos , Cifoplastia/mortalidad , Cifoplastia/tendencias , Masculino , Morbilidad , Mortalidad/tendencias , Readmisión del Paciente/normas , Estudios Prospectivos , Mejoramiento de la Calidad/normas , Fracturas de la Columna Vertebral/cirugía , Estados Unidos/epidemiología , Vertebroplastia/tendencias

RESUMEN

BACKGROUND: Lateral compression pelvic Type I fractures in the elderly population are most often low-energy osteoporosis related fractures. Previous literature comparing pelvic fractures in young versus elderly patients called into question the general consideration of these injuries as benign injuries with favorable prognoses; however, the geriatric population older than 80 years is often underrepresented. This article focuses on the mortality and functional outcomes after low-energy pelvic fractures in a population of patients older than 80 years. METHODS: We prescreened potential subjects in a Level I trauma institution's electronic medical record database between January 1, 2002, and April 30, 2012, to identify isolated lateral compression Type 1 fractures treated nonoperatively in patients older than 80 years. This study was composed of a retrospective review of medical records followed by a prospective survey data collection to examine mechanisms of injury, length of hospital stay, complications, medical comorbidities, ambulatory function, living situation, pain, and 1 year mortality rates. RESULTS: We present a large case series of 85 patients older than 80 years and report a 1-year mortality rate of 20%. We found that patients who were household ambulators or nonfunctional ambulators were five times more likely (24.4% vs. 6.1%) to die within 1 year after injury. Multivariate logistic regression confirmed that the risk of 1-year mortality was significantly higher for household-bound patients compared with community ambulators, independent of sex, smoking, Charlson comorbidity index, or length of hospital stay. CONCLUSION: This is the first study to demonstrate a difference in 1-year mortality between patients who were community ambulators versus those who were household ambulators or nonfunctional ambulators before injury. With our aging population, these findings have important implications. Maintenance of general conditioning and early mobilization with physical therapy after injury is a key part of geriatric orthopedic rehabilitation. LEVEL OF EVIDENCE: Prognostic and epidemiologic, level IV.

Asunto(s)

Actividades Cotidianas , Fracturas por Compresión/mortalidad , Evaluación Geriátrica , Fracturas de Cadera/mortalidad , Caminata/fisiología , Anciano de 80 o más Años , Causas de Muerte , Estudios de Cohortes , Bases de Datos Factuales , Femenino , Estudios de Seguimiento , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/mortalidad , Fracturas por Compresión/diagnóstico , Fracturas por Compresión/cirugía , Fracturas de Cadera/diagnóstico , Fracturas de Cadera/cirugía , Humanos , Modelos Logísticos , Masculino , Análisis Multivariante , Complicaciones Posoperatorias/mortalidad , Complicaciones Posoperatorias/fisiopatología , Periodo Preoperatorio , Pronóstico , Estudios Retrospectivos , Medición de Riesgo , Tasa de Supervivencia , Factores de Tiempo , Centros Traumatológicos , Resultado del Tratamiento

RESUMEN

BACKGROUND: The treatment of vertebral compression fractures with vertebral augmentation procedures is associated with acute pain relief and improved mobility, but direct comparisons of treatments are limited. Our goal was to compare the survival rates, complications, lengths of hospital stay, hospital charges, discharge locations, readmissions, and repeat procedures for Medicare patients with new vertebral compression fractures that had been acutely treated with vertebroplasty, kyphoplasty, or nonoperative modalities. METHODS: The 2006 Medicare Provider Analysis and Review File database was used to identify 72,693 patients with a vertebral compression fracture. Patients with a previous vertebral compression fracture, those who had had a vertebral augmentation procedure in the previous year, those with a diagnosis of malignant neoplasm, and those who had died were excluded, leaving 68,752 patients. The patients were stratified into nonoperative treatment (55.6%), vertebroplasty (11.2%), and kyphoplasty (33.2%) cohorts. Survival rates were compared with use of Kaplan-Meier analysis and Cox regression. Results were adjusted for potential confounding variables. Secondary parameters of interest were analyzed with the chi-square test (categorical variables) and one-way analysis of variance (continuous variables), with the level of significance set at p < 0.05. RESULTS: The estimated three-year survival rates were 42.3%, 49.7%, and 59.9% for the nonoperative treatment, vertebroplasty, and kyphoplasty groups, respectively. The adjusted risk of death was 20.0% lower for the kyphoplasty group than for the vertebroplasty group (hazard ratio = 0.80, 95% confidence interval, 0.77 to 0.84). Patients in the kyphoplasty group had the shortest hospital stay and the highest hospital charges and were the least likely to have had pneumonia and decubitus ulcers during the index hospitalization and at six months postoperatively. However, kyphoplasty was more likely to result in a subsequent augmentation procedure than was vertebroplasty (9.41% compared with 7.89%; p < 0.001). CONCLUSIONS: Vertebral augmentation procedures appear to be associated with longer patient survival than nonoperative treatment does. Kyphoplasty tends to have a more striking association with survival than vertebroplasty does, but it is costly and may have a higher rate of subsequent vertebral compression fracture. These provocative findings may reflect selection bias and should be addressed in a prospective, direct comparison of methods to treat vertebral compression fractures. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Asunto(s)

Fracturas por Compresión/terapia , Cifoplastia/mortalidad , Fracturas de la Columna Vertebral/terapia , Vertebroplastia/mortalidad , Anciano , Femenino , Fracturas por Compresión/economía , Fracturas por Compresión/mortalidad , Precios de Hospital , Humanos , Estimación de Kaplan-Meier , Cifoplastia/economía , Tiempo de Internación/economía , Tiempo de Internación/estadística & datos numéricos , Masculino , Medicare/economía , Alta del Paciente/economía , Alta del Paciente/estadística & datos numéricos , Complicaciones Posoperatorias/economía , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/mortalidad , Estudios Prospectivos , Reoperación/economía , Reoperación/estadística & datos numéricos , Fracturas de la Columna Vertebral/economía , Estados Unidos/epidemiología , Vertebroplastia/economía

RESUMEN

SUMMARY: The life expectancy of vertebral compression fracture (VCF) patients was evaluated as a function of their treatment. Compared to non-operated patients, the kyphoplasty and vertebroplasty patient cohort had 115% and 44% greater adjusted life expectancy, respectively. Kyphoplasty patients had a 34% greater adjusted life expectancy than vertebroplasty patients. INTRODUCTION: Balloon kyphoplasty and vertebroplasty are minimally invasive procedures for the treatment of painful VCFs. This comparative effectiveness study characterized the life expectancy of VCF patients as a function of their treatment. METHODS: Life expectancy of VCF patients in the 100% U.S. Medicare dataset (2005-2008) was estimated using a parametric Weibull survival model (adjusted for comorbidities), and compared between operated and non-operated patients as well as between kyphoplasty and vertebroplasty patients. A total of 858,978 patients with a newly diagnosed VCF were identified, including 119,253 kyphoplasty patients (13.9%) and 63,693 vertebroplasty patients (7.4%). RESULTS: Adjusted life expectancy was 85% greater for operated than non-operated patients (p < 0.001; 95% confidence interval: 82-89%). Compared to non-operated patients, the kyphoplasty and vertebroplasty patient cohort had 115% (p < 0.001; 95% confidence interval: 111-119%) and 44% (p < 0.001; 95% confidence interval: 42-47%) greater adjusted life expectancy, respectively. Kyphoplasty patients had a 34% greater adjusted life expectancy than vertebroplasty patients (p < 0.001; 95% confidence interval: 31-36%). Across all gender-age groups, the median life expectancy predicted by the parametric Weibull model was 2.2-7.3 years greater for operated than non-operated patients. CONCLUSIONS: Statistically significant and substantial differences in life expectancy were observed between the treated and non-treated cohorts in the Medicare population. Among the treated cohorts, patients in the vertebroplasty group experienced less of a survival benefit than those who received kyphoplasty. The results will be a useful basis for future cost effectiveness studies of VCF treatments for the Medicare population.

Asunto(s)

Fracturas por Compresión/mortalidad , Esperanza de Vida , Fracturas de la Columna Vertebral/mortalidad , Vertebroplastia/métodos , Factores de Edad , Anciano , Anciano de 80 o más Años , Investigación sobre la Eficacia Comparativa , Femenino , Fracturas por Compresión/cirugía , Humanos , Cifoplastia/métodos , Masculino , Medicare , Factores Sexuales , Fracturas de la Columna Vertebral/cirugía , Análisis de Supervivencia , Resultado del Tratamiento , Estados Unidos/epidemiología

RESUMEN

For over 10 years, kyphoplasty has been established for the treatment of painful osteoporotic vertebral compression fractures. Its effectiveness has been substantiated in multiple clinical studies. Not only is prompt pain reduction achieved, but according to a new, large, long-term study, long-term survival is also increased. Balloon kyphoplasty was performed for 564 patients from 1 January 2008 until 31 July 2011. In all cases, pain was rated more than 6/10 points, and recent fracture was evident on cross-sectional imaging (CT or MRT) performed to supplement spine x-rays. Average patient age was 75.3 years; 71.3% of patients were female. Treated fracture levels ranged from Th3 to L5. A single level was treated in 372 cases, with two levels treated simultaneously in 128 cases, three levels in 48 cases, and four levels in 22 cases. Average operative time for all patients was 36 min. Eight different surgeons performed the procedures. Average convalescence time was 8 days which decreased progressively over the years. Pain was reduced from 8 preoperative to 2.4 points postoperative in the visual analogue scale. Six major complications (1.06%) occurred. Kyphoplasty is a good procedure to treat painful osteoporotic fractures from the lumbar to thoracic spine. Major complications occur seldom after kyphoplasty; however, they must be considered and clarified.

Asunto(s)

Fracturas por Compresión/cirugía , Fracturas Osteoporóticas/cirugía , Fracturas de la Columna Vertebral/cirugía , Anciano , Anciano de 80 o más Años , Causas de Muerte , Convalecencia , Extravasación de Materiales Terapéuticos y Diagnósticos/diagnóstico , Extravasación de Materiales Terapéuticos y Diagnósticos/etiología , Extravasación de Materiales Terapéuticos y Diagnósticos/mortalidad , Femenino , Fracturas por Compresión/diagnóstico , Fracturas por Compresión/mortalidad , Alemania , Mortalidad Hospitalaria , Humanos , Interpretación de Imagen Asistida por Computador , Tiempo de Internación , Vértebras Lumbares/cirugía , Imagen por Resonancia Magnética , Masculino , Fracturas Osteoporóticas/diagnóstico , Fracturas Osteoporóticas/mortalidad , Dimensión del Dolor , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/mortalidad , Fracturas de la Columna Vertebral/diagnóstico , Fracturas de la Columna Vertebral/mortalidad , Vértebras Torácicas/cirugía , Tomografía Computarizada por Rayos X

RESUMEN

PURPOSE: The incidence of osteoporotic fractures is increasing with an ageing population. This has potential consequences for health services, patients and their families. Treatment of osteoporotic vertebral compression fractures (OVCFs) has been limited to non-surgical measures so far. The social and functional consequences of balloon kyphoplasty, a recent development for the treatment of VCF, were assessed in this cohort study. METHODS: Data collected prospectively from 53 patients undergoing balloon kyphoplasty for symptomatic OVCF in our hospital's spinal unit were compared with data from an historical age-matched group of 51 consecutive patients treated conservatively for symptomatic OVCF. Social functionality was recorded prior to the injury, and at 6-month and 1-year follow-up; mortality was recorded at 6 months and 1 year. RESULTS: The mortality rate in the balloon kyphoplasty group was 11 % (6/53) at 1 year post-OVCF, versus 22 % (11/51) in the conservatively treated controls. A drift to a lower level of social functionality (defined by a lower level of independence) was observed at 1 year in 21 % of patients in the balloon kyphoplasty group versus 53 % of patients in the conservatively treated group. A drift to a lower level of independence was noted in 67 % of the conservatively treated patients who started at a lower level of functionality versus 20 % drift in a similar group who were treated with balloon kyphoplasty. CONCLUSIONS: The reduction in mortality and drift in social functionality at 1 year following treatment with balloon kyphoplasty suggests that it is a viable option for the management of OVCFs.

Asunto(s)

Fracturas por Compresión/cirugía , Vida Independiente/estadística & datos numéricos , Cifoplastia , Fracturas Osteoporóticas/cirugía , Fracturas de la Columna Vertebral/cirugía , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Fracturas por Compresión/mortalidad , Fracturas por Compresión/rehabilitación , Humanos , Masculino , Persona de Mediana Edad , Fracturas Osteoporóticas/mortalidad , Fracturas Osteoporóticas/rehabilitación , Fracturas de la Columna Vertebral/mortalidad , Fracturas de la Columna Vertebral/rehabilitación , Resultado del Tratamiento , Reino Unido

RESUMEN

BACKGROUND AND PURPOSE: Vertebroplasty is an effective treatment for painful compression fractures refractory to conservative management. Because there are limited data regarding the survival characteristics of this patient population, we compared the survival of a treated with an untreated vertebral fracture cohort to determine whether vertebroplasty affects mortality rates. MATERIALS AND METHODS: The survival of a treated cohort, comprising 524 vertebroplasty recipients with refractory osteoporotic vertebral compression fractures, was compared with a separate historical cohort of 589 subjects with fractures not treated by vertebroplasty who were identified from the Rochester Epidemiology Project. Mortality was compared between cohorts by using Cox proportional hazards models adjusting for age, sex, and Charlson indices of comorbidity. Mortality was also correlated with pre-, peri-, and postprocedural clinical metrics (eg, cement volume use, RDQ score, analog pain scales, frequency of narcotic use, and improvement in mobility) within the treated cohort. RESULTS: Vertebroplasty recipients demonstrated 77% of the survival expected for individuals of similar age, ethnicity, and sex within the US population. Compared with individuals with both symptomatic and asymptomatic untreated vertebral fractures, vertebroplasty recipients retained a 17% greater mortality risk. However, compared with symptomatic untreated vertebral fractures, vertebroplasty recipients had no increased mortality following adjustment for differences in age, sex, and comorbidity (HR, 1.02; 95% CI, 0.82-1.25). In addition, no clinical metrics used to assess the efficacy of vertebroplasty were predictive of survival. CONCLUSIONS: Vertebroplasty recipients have mortality rates similar to those of individuals with untreated symptomatic fractures but have worse mortality compared with those with asymptomatic vertebral fractures.

Asunto(s)

Fracturas por Compresión/mortalidad , Fracturas por Compresión/terapia , Osteoporosis/mortalidad , Osteoporosis/terapia , Fracturas de la Columna Vertebral/mortalidad , Fracturas de la Columna Vertebral/terapia , Vertebroplastia/mortalidad , Anciano , Estudios de Cohortes , Comorbilidad , Femenino , Humanos , Masculino , Minnesota/epidemiología , Prevalencia , Medición de Riesgo , Factores de Riesgo , Análisis de Supervivencia , Tasa de Supervivencia , Resultado del Tratamiento

RESUMEN

We performed an analysis of following costs after primary conservative or operative treatment with balloon kyphoplasty (BKP) in osteoporotic vertebral fractures. Patients with primary osteoporotic vertebral fractures treated with BKP or conservatively from discharge year 2002-2005 were retrospectively assessed regarding the following hospital treatment in any hospital in Austria from 2002 to 2006. A statistical record linkage between the hospital data and the mortality registry of Statistic Austria was performed. The data search was restricted to ICD-10 and procedures according to the Austrian catalogue of procedures defined as "spine relevant". Number of readmissions, length of hospital stay and DRG related costs were calculated for the surgical and conservative group separately. 324.5 years (mean 2.93 ± 1.40, conservative group) and 343.6 (mean 2.56 ± 0.96, BKP group) of 110 conservative patients and 134 BKP patients were analyzed. There was no statistical difference of the mortality rate with 9 patients (6.7%, BKP) and 11 patients (9.9%, conservative). The number of readmissions was 1.62 times higher (P = 0.039), the length of stay 1.09 times higher (P = 0.046) in the conservative group. No difference in the DRG scores were found (P = 0.11). In conclusion, patients with osteoporotic vertebral fractures showed in the following years after BKP fewer hospital readmissions and shorter hospital stays but no difference in DRG scores in comparison to conservatively treated patients.

Asunto(s)

Fracturas por Compresión/economía , Fracturas por Compresión/terapia , Costos de la Atención en Salud , Hospitalización , Pacientes Internos , Cifoplastia/economía , Fracturas de la Columna Vertebral/economía , Fracturas de la Columna Vertebral/terapia , Adulto , Anciano , Anciano de 80 o más Años , Austria , Femenino , Fracturas por Compresión/mortalidad , Costos de la Atención en Salud/tendencias , Humanos , Cifoplastia/métodos , Masculino , Persona de Mediana Edad , Fracturas Osteoporóticas/economía , Fracturas Osteoporóticas/terapia , Estudios Retrospectivos , Fracturas de la Columna Vertebral/mortalidad

RESUMEN

Vertebral compression fractures (VCFs) are associated with increased mortality risk, but the association between surgical treatment and survivorship is unclear. We evaluated the mortality risk for VCF patients undergoing conservative treatment (nonoperated), kyphoplasty, and vertebroplasty. Survival of VCF patients in the 100% U.S. Medicare data set (2005-2008) was estimated by the Kaplan-Meier method, and the differences in mortality rates at up to 4 years were assessed by Cox regression (adjusted for comorbidities) between operated and nonoperated patients and between kyphoplasty and vertebroplasty patients. An instrumental variables analysis was used to evaluate mortality-rate difference between kyphoplasty and vertebroplasty patients. A total of 858,978 VCF patients were identified, including 119,253 kyphoplasty patients and 63,693 vertebroplasty patients. At up to 4 years of follow-up, patients in the operated cohort had a higher adjusted survival rate of 60.8% compared with 50.0% for patients in the nonoperated cohort (p < .001) and were 37% less likely to die [adjusted hazard ratio (HR) = 0.63, p < .001]. The adjusted survival rates for VCF patients following vertebroplasty or kyphoplasty were 57.3% and 62.8%, respectively (p < .001). The relative risk of mortality for kyphoplasty patients was 23% lower than that for vertebroplasty patients (adjusted HR = 0.77, p < .001). Using physician preference as an instrument, the absolute difference in the adjusted survival rate at 3 years was 7.29% higher in patients receiving kyphoplasty than vertebroplasty (p < .001), compared with a crude absolute rate difference of 5.09%. This study established the mortality risk associated with VCFs diagnosed between 2005 and 2008 with respect to different treatment modalities for elderly patients in the entire Medicare population.

Asunto(s)

Fracturas por Compresión/mortalidad , Fracturas por Compresión/cirugía , Medicare/estadística & datos numéricos , Fracturas de la Columna Vertebral/mortalidad , Fracturas de la Columna Vertebral/cirugía , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Fracturas por Compresión/diagnóstico , Humanos , Masculino , Factores de Riesgo , Fracturas de la Columna Vertebral/diagnóstico , Estados Unidos/epidemiología

RESUMEN

BACKGROUND: Our goal was to analyze whether radiographic fracture pattern correlates with mortality of patients with lateral compression type 1 (LC1) fractures. METHODS: We conducted a retrospective case-controlled study at a Level I trauma center. Radiographs and outcome data were obtained for 52 patients with LC1 fractures who died and 63 who lived. LC1 fractures were classified by Denis zone of sacral injury and presence of fracture displacement. Our main outcome measurement was mortality during index hospital admission. RESULTS: No difference was observed in frequency of higher energy Denis zone II sacral fractures between patients with LC1 fractures who died (73.1%) and those who lived (69.8%, p = 0.86, χ²). No difference was observed in number of displaced fractures (50.0% vs. 34.9%, p = 0.15, χ²). Patients who died were more likely to have significant brain injury (69.2% vs. 14.2%, p < 0.0001, χ²), chest injury (73.1% vs. 49.2%, p < 0.05, χ²), or abdominal injury (30.8% vs. 9.5%, p < 0.05, χ²) than those who lived. CONCLUSION: Sacral fracture pattern does not seem to be predictive of mortality for patients with LC1 pelvic fractures The presence of associated injuries seems to be the key driver of mortality.

Asunto(s)

Fracturas Conminutas/diagnóstico por imagen , Fracturas Conminutas/mortalidad , Fracturas por Compresión/diagnóstico por imagen , Fracturas por Compresión/mortalidad , Traumatismo Múltiple/diagnóstico por imagen , Traumatismo Múltiple/mortalidad , Huesos Pélvicos/lesiones , Sacro/lesiones , Fracturas de la Columna Vertebral/diagnóstico por imagen , Fracturas de la Columna Vertebral/mortalidad , Adulto , Anciano , Tornillos Óseos , Estudios de Casos y Controles , Causas de Muerte , Fijadores Externos , Femenino , Fijación Interna de Fracturas , Fracturas Conminutas/cirugía , Fracturas por Compresión/cirugía , Mortalidad Hospitalaria , Hospitales Universitarios/estadística & datos numéricos , Humanos , Masculino , Maryland , Persona de Mediana Edad , Traumatismo Múltiple/cirugía , Huesos Pélvicos/diagnóstico por imagen , Huesos Pélvicos/cirugía , Radiografía , Estudios Retrospectivos , Factores de Riesgo , Sacro/diagnóstico por imagen , Sacro/cirugía , Fracturas de la Columna Vertebral/cirugía , Índices de Gravedad del Trauma

RESUMEN

OBJECTIVES: The objectives of this study were to evaluate the ability of the Young-Burgess classification system to predict mortality, transfusion requirements, and nonorthopaedic injuries in patients with pelvic ring fractures and to determine whether mortality rates after pelvic fractures have changed over time. DESIGN: Retrospective review. SETTING: Level I trauma center. PATIENTS: One thousand two hundred forty-eight patients with pelvic fractures during a 7-year period. INTERVENTION: None. MAIN OUTCOME MEASUREMENTS: Mortality at index admission, transfusion requirement during first 24 hours, and presence of nonorthopaedic injuries as a function of Young-Burgess pelvic classification type. Mortality compared with historic controls. RESULTS: Despite a relatively large sample size, the ability of the Young-Burgess system to predict mortality only approached statistical significance (P = 0.07, Kruskal-Wallis). The Young-Burgess system differentiated transfusion requirements--lateral compression Type 3 (LC3) and anteroposterior compression Types 2 (APC2) and 3 (APC3) fractures had higher transfusion requirements than did lateral compression Type 1 (LC1), anteroposterior compression Type 1 (APC1), and vertical shear (VS) (P < 0.05)--but was not as useful at predicting head, chest, or abdomen injuries. Dividing fractures into stable and unstable types allowed the system to predict mortality rates, abdomen injury rates, and transfusion requirements. Overall mortality in the study group was 9.1%, unchanged from original Young-Burgess studies 15 years previously (P = 0.3). CONCLUSIONS: The Young-Burgess system is useful for predicting transfusion requirements. For the system to predict mortality or nonorthopaedic injuries, fractures must be divided into stable (APC1, LC1) and unstable (APC2, APC3, LC2, LC3, VS, combined mechanism of injury) types. LC1 injuries are very common and not always benign (overall mortality rate, 8.2%).

Asunto(s)

Transfusión Sanguínea/estadística & datos numéricos , Fracturas por Compresión/clasificación , Huesos Pélvicos/lesiones , Comorbilidad , Fracturas por Compresión/mortalidad , Fracturas por Compresión/terapia , Humanos , Maryland/epidemiología , Huesos Pélvicos/diagnóstico por imagen , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Tasa de Supervivencia , Tomografía Computarizada por Rayos X , Centros Traumatológicos , Índices de Gravedad del Trauma

Asunto(s)

Transfusión Sanguínea/estadística & datos numéricos , Fracturas por Compresión/clasificación , Huesos Pélvicos/lesiones , Accidentes de Tránsito/estadística & datos numéricos , Comorbilidad , Fracturas por Compresión/mortalidad , Fracturas por Compresión/terapia , Humanos , Maryland/epidemiología , Huesos Pélvicos/diagnóstico por imagen , Valor Predictivo de las Pruebas , Choque Hemorrágico/mortalidad , Tasa de Supervivencia , Tomografía Computarizada por Rayos X , Centros Traumatológicos , Triaje

RESUMEN

SUMMARY: Balloon kyphoplasty (BKP) is a procedure used to treat vertebral compression fractures (VCFs). We developed a cost-effectiveness model to evaluate BKP in United Kingsdom patients with hospitalised VCFs and estimated the cost-effectiveness of BKP compared to non-surgical management. The results indicate that BKP provides a cost-effective alternative for treating these patients. INTRODUCTION: VCFs of osteoporotic patients are associated with chronic pain, a reduction in health-related quality of life (QoL) and high healthcare costs. BKP is a minimally invasive procedure that has resulted in pain relief, vertebral body height-restoration, decreased kyphosis and improved physical functioning in patients with symptomatic VCFs. BKP was shown to improve health-related QoL in a 12-month interim analysis of a randomised phase-III trial. METHODS: The objectives of this study were to develop a Markov cost-effectiveness model to evaluate BKP in patients with painful hospitalised VCFs and to estimate the cost-effectiveness of BKP compared with non-surgical management in a UK setting. It was assumed that QoL-benefits found at 12 months linearly approached zero during another 2 years, and that patients receiving BKP warranted six fewer hospital bed days compared with patients given non-surgical management. RESULTS: The procedure was associated with quality-adjusted life-years (QALY)-gains of 0.17 and cost/QALY-gains at 8,800 pound sterling. The results were sensitive to assumptions about avoided length of hospital-stay and persistence of kyphoplasty-related QoL-benefits. CONCLUSION: In conclusion, the results indicate that BKP provides a cost-effective alternative for treating patients with hospitalised VCFs in a UK-setting.

Asunto(s)

Fracturas por Compresión/cirugía , Cifoplastia/economía , Modelos Econométricos , Fracturas Osteoporóticas/cirugía , Fracturas de la Columna Vertebral/cirugía , Anciano , Cateterismo/economía , Análisis Costo-Beneficio , Femenino , Fracturas por Compresión/economía , Fracturas por Compresión/mortalidad , Costos de la Atención en Salud/estadística & datos numéricos , Humanos , Cifoplastia/métodos , Tiempo de Internación/estadística & datos numéricos , Masculino , Fracturas Osteoporóticas/economía , Fracturas Osteoporóticas/mortalidad , Calidad de Vida , Fracturas de la Columna Vertebral/economía , Fracturas de la Columna Vertebral/mortalidad , Reino Unido/epidemiología

RESUMEN

BACKGROUND: Vertebral compression fractures in women are associated with increased mortality, but the generality of this finding, as a function of age, sex, ethnicity, and region, among the entire elderly population in the United States remains unclear. The objective of this study was to assess the survival of the Medicare population with vertebral compression fractures. METHODS: We conducted a retrospective data analysis of Medicare claims generated by a 5% sample of all Medicare enrollees from 1997 through 2004. The patient sample consisted of all 97,142 individuals with a new diagnosis of vertebral compression fracture from 1997 through 2004. Controls were matched for age, sex, race, and Medicare buy-in status, with a five-to-one control-case ratio. The survival of a patient was measured from the earliest date of a new fracture until death or until the end of the study. The patients with a fracture were compared with the controls by calculation of the mortality rates, with use of Kaplan-Meier analysis and the Cox regression method. Demographic subpopulation analysis and analysis by comorbidity levels were performed as well. RESULTS: Medicare patients with a vertebral fracture had an overall mortality rate that was approximately twice that of the matched controls. The survival rates following a fracture diagnosis, as estimated with the Kaplan-Meier method, were 53.9%, 30.9%, and 10.5% at three, five, and seven years, respectively, which were consistently and significantly lower than the rates for the controls. The mortality risk following a fracture was greater for men than for women. The difference in mortality between the patients with a vertebral compression fracture and the controls was greatest when the patients were younger at the time of the fracture; this difference declined as the age at the time of the fracture increased. CONCLUSIONS: This study establishes the mortality risk associated with vertebral fractures for elderly patients of all ages and ethnicities and both sexes in the Medicare population; however, it does not imply a causal relationship. The difference in mortality between patients with a fracture and controls is higher than previously reported, even after controlling for comorbidities.

Asunto(s)

Fracturas por Compresión/mortalidad , Fracturas de la Columna Vertebral/mortalidad , Anciano , Anciano de 80 o más Años , Femenino , Fracturas por Compresión/diagnóstico , Humanos , Masculino , Medicare , Estudios Retrospectivos , Población Rural , Fracturas de la Columna Vertebral/diagnóstico , Población Suburbana , Estados Unidos