Department of Radiology, School of Medicine, University of Washington, Seattle, WA, USA; Clinical Learning, Evidence, and Research Center, University of Washington, Seattle, WA, USA.
Department of Radiology, School of Medicine, University of Washington, Seattle, WA, USA; Clinical Learning, Evidence, and Research Center, University of Washington, Seattle, WA, USA.
Spine J. 2021 Aug;21(8):1347-1354. doi: 10.1016/j.spinee.2021.03.025. Epub 2021 Mar 26.
Osteoporotic vertebral fractures (OVFs) can lead to severe pain and reduced function and quality-of-life, but the strength of evidence for treatments remains low, particularly in younger populations.
To determine whether patients with OVFs who received kyphoplasty had different patterns of healthcare utilization compared to propensity-matched patients who did not receive vertebral augmentation.
Observational cohort study.
We identified patients with OVFs from 2007 to 2018 in the IBM MarketScan Commercial Claims and Encounters Databases who received kyphoplasty and compared them to propensity-matched controls who did not receive vertebral augmentation (either kyphoplasty or vertebroplasty).
Major medical complications within 30 days, fills of opioids from 1-week through 1-month postaugmentation, and spine-related gross covered payments from 3-days postkyphoplasty through 1-year post-OVF.
We used logistic regression to obtain odds ratios (ORs) and 95% confidence intervals (95% CIs) to compare binary outcomes and median analysis to compare continuous outcomes.
Of the 15,197 OVF patients identified, 1,969 (13%) received kyphoplasty and 1,928 (98%) of these were propensity matched to nonaugmented controls. We did not observe differences in the odds of major medical complications within 30 days (adjusted OR [95% CI]: 1.0 [0.6, 1.8]) but patients who received kyphoplasty were more likely to have filled opioid medications within 30 days (adjusted OR [95% CI]: 1.3 [1.1, 1.5]) and had greater spine-related gross covered payments (kyphoplasty median [95% CI]: $1,340 [$240, $4,850]; nonaugmented: $7,870 [$7,480, $8,270]; adjusted difference in medians [95% CI]: $260 [$190, $2,050]).
In this cohort of patients <65 years, receipt of kyphoplasty was associated with greater likelihood of opioid fills and somewhat greater spine-related gross covered payments, but no difference in major medical complications. In this retrospective study of administrative data, we did not detect advantages of treatment with kyphoplasty compared with nonaugmentation for any of our outcomes.
骨质疏松性椎体骨折（OVFs）可导致严重疼痛和功能及生活质量下降，但治疗效果的证据强度仍然较低，尤其是在年轻人群中。
确定接受椎体后凸成形术的 OVF 患者与未接受椎体增强术的倾向匹配患者相比，其医疗保健利用模式是否存在差异。
观察性队列研究。
我们从 2007 年至 2018 年 IBM MarketScan 商业索赔和就诊数据库中确定了接受椎体后凸成形术的 OVF 患者，并将其与未接受椎体增强术（椎体后凸成形术或经皮椎体成形术）的倾向匹配对照组进行比较。
术后 30 天内主要医疗并发症、术后 1 周到 1 个月内阿片类药物的填充量以及术后 3 天至 OVF 后 1 年的脊柱相关总覆盖支付额。
我们使用逻辑回归获得优势比（OR）和 95%置信区间（95%CI）来比较二项结局指标，使用中位数分析来比较连续结局指标。
在确定的 15197 例 OVF 患者中，有 1969 例（13%）接受了椎体后凸成形术，其中 1928 例（98%）与未增强对照组进行了倾向匹配。我们未观察到术后 30 天内主要医疗并发症的发生概率存在差异（校正 OR [95%CI]：1.0 [0.6, 1.8]），但接受椎体后凸成形术的患者在术后 30 天内更有可能使用阿片类药物（校正 OR [95%CI]：1.3 [1.1, 1.5]），并且脊柱相关总覆盖支付额更高（椎体后凸成形术中位数 [95%CI]：$1340 [240，$4850]；未增强：$7870 [7480，$8270]；校正中位数差异 [95%CI]：$260 [$190，$2050]）。
在该年龄<65 岁的患者队列中，接受椎体后凸成形术与阿片类药物填充的可能性增加以及与脊柱相关的总覆盖支付额略有增加相关，但与主要医疗并发症无关。在这项回顾性的行政数据研究中，我们没有发现与非增强治疗相比，椎体后凸成形术在任何结局方面具有优势。
