Medtronic, Inc, 1221 Crossman Ave, Sunnyvale, CA 94089, USA.
J Bone Miner Res. 2011 Jul;26(7):1617-26. doi: 10.1002/jbmr.353.
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.
椎体压缩性骨折（VCF）与死亡率风险增加相关，但手术治疗与存活率之间的关联尚不清楚。我们评估了接受保守治疗（未手术）、后凸成形术和椎体成形术的 VCF 患者的死亡率风险。使用 Kaplan-Meier 方法估计了 100%美国医疗保险数据集中（2005-2008 年）的 VCF 患者的生存率，并通过 Cox 回归（调整了合并症）评估了 4 年内手术与非手术患者以及后凸成形术与椎体成形术患者之间的死亡率差异。使用工具变量分析评估了后凸成形术与椎体成形术患者之间的死亡率差异。共确定了 858978 例 VCF 患者，其中包括 119253 例后凸成形术患者和 63693 例椎体成形术患者。在长达 4 年的随访中，手术组患者的调整后生存率为 60.8%，而未手术组患者的生存率为 50.0%（p<0.001），死亡风险降低了 37%[调整后的危险比（HR）=0.63，p<0.001]。接受椎体成形术或后凸成形术治疗的 VCF 患者的调整后生存率分别为 57.3%和 62.8%（p<0.001）。后凸成形术患者的死亡相对风险比椎体成形术患者低 23%（调整后的 HR=0.77，p<0.001）。使用医生偏好作为工具，接受后凸成形术治疗的患者在 3 年内的调整后生存率比接受椎体成形术治疗的患者高 7.29%（p<0.001），而粗死亡率差异为 5.09%。本研究确定了 2005 年至 2008 年期间在整个 Medicare 人群中不同治疗方式与老年患者 VCF 相关的死亡率风险。
