Radiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
Radiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
J Neurointerv Surg. 2021 May;13(5):483-491. doi: 10.1136/neurintsurg-2020-016733. Epub 2020 Dec 17.
To explore the national inpatient trends, regional variations, associated diagnoses, and outcomes of vertebral augmentation (vertebroplasty and kyphoplasty) in the USA from 2004 to 2017.
Data from the National Inpatient Sample were used to study hospitalization records for percutaneous vertebroplasty and kyphoplasty. Longitudinal projections of trends and outcomes, including mortality, post-procedural complications, length of stay, disposition, and total hospital charges were analyzed.
Following a period of decreased utilization from 2008 to 2012, hospitalizations for vertebroplasty and kyphoplasty plateaued after 2013. Total hospital charges and overall financial burden of hospitalizations for vertebroplasty and kyphoplasty increased to a peak of $1.9 billion (range $1.7-$2.2 billion) in 2017. Overall, 8% of procedures were performed in patients with a history of malignancy. In multivariable modeling, lung cancer (adjusted OR (aOR) 2.6 (range 1.4-5.1)) and prostate cancer (aOR 3.4 (range 1.2-9.4)) were associated with a higher risk of mortality. The New England region had the lowest frequency of routine disposition (14.1±1.1%) and the lowest average hospital charges ($47 885±$1351). In contrast, 34.0±0.8% had routine disposition in the West Central South region, and average hospital charges were as high as $99 836±$2259 in the Pacific region. The Mountain region had the lowest number of procedures (5365±272) and the highest mortality rate (1.2±0.3%).
National inpatient trends of vertebroplasty and kyphoplasty utilization remained stable after a period of decline from 2008 to 2012, while the financial burden of hospitalizations increased. Despite recent improvements in outcomes, significant regional variations persisted across the USA.
本研究旨在探讨 2004 年至 2017 年期间美国经皮椎体成形术和椎体后凸成形术的国家住院趋势、地区差异、相关诊断和结局。
本研究使用国家住院患者样本数据库研究经皮椎体成形术和椎体后凸成形术的住院记录。对趋势和结局的长期预测值，包括死亡率、术后并发症、住院时间、出院情况和总住院费用进行分析。
在经历了 2008 年至 2012 年期间利用度下降之后，2013 年后经皮椎体成形术和椎体后凸成形术的住院人数趋于平稳。2017 年，经皮椎体成形术和椎体后凸成形术的总住院费用和总住院费用负担达到峰值 19 亿美元（范围 17 亿至 22 亿美元）。总体而言，8%的手术是在有恶性肿瘤病史的患者中进行的。多变量模型分析显示，肺癌（校正比值比[aOR] 2.6（范围 1.4-5.1））和前列腺癌（aOR 3.4（范围 1.2-9.4））与死亡率升高相关。新英格兰地区常规出院率最低（14.1±1.1%），平均住院费用最低（47885±1351 美元）。相比之下，中西南部地区有 34.0±0.8%的患者常规出院，而太平洋地区的平均住院费用高达 99836±2259 美元。山区手术数量最少（5365±272），死亡率最高（1.2±0.3%）。
2008 年至 2012 年期间经皮椎体成形术和椎体后凸成形术的国家住院人数呈下降趋势，此后利用度保持稳定，而住院费用负担增加。尽管近期结局有所改善，但美国各地仍存在显著的地区差异。
