Laura S Gold1, Michael K O'Reilly2, Patrick J Heagerty3, Jeffrey G Jarvik2. 1. Department of Radiology, School of Medicine, University of Washington, Seattle, WA, USA; Clinical Learning, Evidence, and Research Center, University of Washington, Seattle, WA, USA. Electronic address: goldl@uw.edu. 2. Department of Radiology, School of Medicine, University of Washington, Seattle, WA, USA; Clinical Learning, Evidence, and Research Center, University of Washington, Seattle, WA, USA. 3. Clinical Learning, Evidence, and Research Center, University of Washington, Seattle, WA, USA; Department of Biostatistics, University of Washington, Seattle, WA, USA.
Abstract
BACKGROUND CONTEXT: 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. PURPOSE: 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. DESIGN: Observational cohort study. PATIENT SAMPLE: 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). OUTCOME MEASURES: 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. METHODS: 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. RESULTS: 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]). CONCLUSIONS: 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.
BACKGROUND CONTEXT: 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. PURPOSE: 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. DESIGN: Observational cohort study. PATIENT SAMPLE: 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). OUTCOME MEASURES: 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. METHODS: 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. RESULTS: 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]). CONCLUSIONS: 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.
Authors: Douglas Wardlaw; Steven R Cummings; Jan Van Meirhaeghe; Leonard Bastian; John B Tillman; Jonas Ranstam; Richard Eastell; Peter Shabe; Karen Talmadge; Steven Boonen Journal: Lancet Date: 2009-02-24 Impact factor: 79.321
Authors: Matthew A Hazzard; Kevin T Huang; Ulysses N Toche; Beatrice Ugiliweneza; Chirag G Patil; Maxwell Boakye; Shivanand P Lad Journal: Asian Spine J Date: 2014-10-18
Authors: Jan Van Meirhaeghe; Leonard Bastian; Steven Boonen; Jonas Ranstam; John B Tillman; Douglas Wardlaw Journal: Spine (Phila Pa 1976) Date: 2013-05-20 Impact factor: 3.468
Authors: Cristina E Firanescu; Jolanda de Vries; Paul Lodder; Alexander Venmans; Marinus C Schoemaker; Albert J Smeets; Esther Donga; Job R Juttmann; Caroline A H Klazen; Otto E H Elgersma; Frits H Jansen; Alexander V Tielbeek; Issam Boukrab; Karen Schonenberg; Willem Jan J van Rooij; Joshua A Hirsch; Paul N M Lohle Journal: BMJ Date: 2018-05-09