College of Saint Benedict/Saint John's University, St. Joseph, Minnesota, USA.
AJNR Am J Neuroradiol. 2011 Apr;32(4):647-8. doi: 10.3174/ajnr.A2371. Epub 2011 Feb 24.
Our aim was to determine whether referral patterns and rates of vertebroplasties at the Mayo Clinic have changed after the publication of the INVEST and the Australian Trial. In August of 2009, we performed a retrospective review of patients undergoing vertebroplasties and those patients who were referred for but did not receive vertebroplasties before and after the recently published placebo-controlled vertebroplasty trials.
After approval by our local institutional review board, we retrospectively evaluated all patients referred for vertebroplasty between January 5, 2004, and June 2, 2010. We catalogued age, sex, number of treated vertebrae, physician referring the patient for vertebroplasty, and the referring department. We calculated the mean number of referrals per month before and after August 2009, which was the month of publication for both trials. We also calculated rates for specific referring physician types.
During the full study, 1188 patients were referred, of whom 807 underwent treatment at 1378 levels for a total of 943 separate vertebroplasty procedures. The mean number of vertebroplasty referrals per month has dropped significantly from 18.9 ± 5.3 (95% CI, 17.7-20.2) before publication to 11.3 ± 3.1 (95% CI, 9.1-13.5) referrals per month after publication (P=.0001). Before publication, 67.3 ± 14.0% (95% CI, 64.0%-70.7%) of patients referred for vertebroplasty underwent vertebroplasty, compared with 76.0 ± 14.9% (95% CI, 65.4%-86.6%) after publication (P=.11).
The number of vertebroplasty referrals at our center has decreased significantly since the publication of INVEST and the Australian Trial, yet we continue to offer the procedure to a high proportion of referred patients.
我们旨在确定在 INVEST 和澳大利亚试验发表后，梅奥诊所的椎体成形术转诊模式和率是否发生了变化。在 2009 年 8 月，我们对接受椎体成形术的患者和在最近发表的安慰剂对照椎体成形术试验之前和之后被转诊但未接受椎体成形术的患者进行了回顾性研究。
在获得我们当地机构审查委员会的批准后，我们回顾性评估了 2004 年 1 月 5 日至 2010 年 6 月 2 日期间所有被转诊行椎体成形术的患者。我们记录了患者的年龄、性别、治疗椎体的数量、转诊行椎体成形术的医生以及转诊科室。我们计算了 2009 年 8 月之前和之后（即两项试验发表的月份）每月的平均转诊人数。我们还计算了特定转诊医生类型的比例。
在整个研究期间，有 1188 名患者被转诊，其中 807 名患者在 1378 个水平接受了治疗，共进行了 943 次单独的椎体成形术。在出版物发表后，每月椎体成形术的转诊人数从发表前的 18.9 ± 5.3（95%可信区间，17.7-20.2）显著下降至每月 11.3 ± 3.1（95%可信区间，9.1-13.5）（P=.0001）。在发表前，有 67.3 ± 14.0%（95%可信区间，64.0%-70.7%）的被转诊行椎体成形术的患者接受了椎体成形术，而在发表后这一比例为 76.0 ± 14.9%（95%可信区间，65.4%-86.6%）（P=.11）。
自 INVEST 和澳大利亚试验发表以来，我们中心的椎体成形术转诊人数显著减少，但我们继续为高比例的转诊患者提供该手术。
