Department of Orthopaedic Surgery, Hahnemann University Hospital, Drexel University College of Medicine, 245 N 15th Street, Philadelphia, PA, 19102, USA.
Clin Orthop Relat Res. 2010 Jul;468(7):1773-80. doi: 10.1007/s11999-010-1279-7.
The majority of the 700,000 osteoporotic vertebral compression fractures (VCFs) that occur annually in the United States affect women. The total treatment costs exceed $17 billion and approximate the total costs of breast cancer ($13 billion) and heart disease ($19 billion). Balloon-assisted percutaneous vertebral augmentation with bone cement (kyphoplasty) reportedly reduces VCF-related pain and accelerates return of independent functional mobility. Kyphoplasty may decrease overall cost of VCF treatment costs by reducing use of posttreatment medical resources.
QUESTIONS/PURPOSES: We evaluated complications, mortality, posthospital disposition, and treatment costs of kyphoplasty compared with nonoperative treatment using the Nationwide Inpatient Sample database.
We identified 5766 VCFs (71% female) in patients 65 years of age or older with nonneoplastic VCF as the primary diagnosis in nonroutine hospital admissions; 15.3% underwent kyphoplasty. Demographic data, medical comorbidities, and fracture treatment type were recorded. Outcomes, including complications, mortality, posthospital disposition, and treatment costs, were compared for each treatment type.
Women were more likely to be treated with kyphoplasty than were men. Patients undergoing kyphoplasty had comorbidity indices equivalent to those treated nonoperatively. Kyphoplasty was associated with a greater likelihood of routine discharge to home (38.4% versus 21.0% for nonoperative treatment), a lower rate of discharge to skilled nursing (26.1% versus 34.8%) or other facilities (35.7% versus 47.1%), a complication rate equivalent to nonoperative treatment (1.7% versus 1.0%), and a lower rate of in-hospital mortality (0.3% versus 1.6%). Kyphoplasty was associated with higher cost of hospitalization (mean $37,231 versus $20,112).
Kyphoplasty for treatment of VCF in well-selected patients may accelerate the return of independent patient function as indicated by improved measures of hospital discharge. The initially higher cost of treatment may be offset by the reduced use of posthospital medical resources.
Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
美国每年发生的 70 万例骨质疏松性椎体压缩性骨折（VCF）中，大多数发生在女性身上。总治疗费用超过 170 亿美元，接近乳腺癌（130 亿美元）和心脏病（190 亿美元）的总和。球囊辅助经皮椎体后凸成形术（骨水泥强化）据称可减轻 VCF 相关疼痛并加速恢复独立功能活动能力。通过减少治疗后医疗资源的使用，球囊辅助经皮椎体后凸成形术可能会降低 VCF 的总体治疗费用。
问题/目的：我们使用全国住院患者样本数据库评估了球囊辅助经皮椎体后凸成形术与非手术治疗相比的并发症、死亡率、住院后去向和治疗费用。
我们在非常规住院患者中确定了 5766 例年龄在 65 岁或以上的 VCF（71%为女性），且原发性诊断为非肿瘤性 VCF；其中 15.3%接受了球囊辅助经皮椎体后凸成形术。记录了人口统计学数据、合并症和骨折治疗类型。比较了每种治疗类型的并发症、死亡率、住院后去向和治疗费用等结果。
女性比男性更有可能接受球囊辅助经皮椎体后凸成形术治疗。接受球囊辅助经皮椎体后凸成形术的患者合并症指数与接受非手术治疗的患者相当。球囊辅助经皮椎体后凸成形术与更高的常规家庭出院率相关（38.4%比非手术治疗的 21.0%），更低的熟练护理或其他设施出院率（26.1%比 34.8%），与非手术治疗相当的并发症发生率（1.7%比 1.0%），以及更低的住院死亡率（0.3%比 1.6%）。球囊辅助经皮椎体后凸成形术与更高的住院费用相关（平均 37231 美元比 20112 美元）。
在精选患者中，球囊辅助经皮椎体后凸成形术治疗 VCF 可能会通过改善出院评估指标来加速患者独立功能的恢复。治疗的初始较高成本可能会因减少使用住院后医疗资源而得到弥补。
III 级，治疗性研究。欲了解完整的证据水平描述，请参见作者指南。
