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Original research
Vertebroplasty and kyphoplasty in the USA from 2004 to 2017: national inpatient trends, regional variations, associated diagnoses, and outcomes
  1. Nima Hafezi-Nejad1,
  2. Christopher R Bailey1,
  3. Alex J Solomon1,
  4. Moustafa Abou Areda1,
  5. John A Carrino2,
  6. Majid Khan1,
  7. Clifford R Weiss1
  1. 1Radiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
  2. 2Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
  1. Correspondence to Dr Nima Hafezi-Nejad, Radiology, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA; nimahn{at}gmail.com

Abstract

Background 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.

Methods 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.

Results 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%).

Conclusion 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.

  • spine
  • intervention
  • economics
  • complication
  • political
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Footnotes

  • Twitter @NimaHNejad, @alexjsolomonIR

  • Contributors All authors approved the final version of the article, including the authorship list. Conception and design: NH-N, CRB and CRW; analysis and interpretation of the data (NH-N, CRB, MK, and CRW); drafting of the article (NH-N, AJS and MAA); critical revision of the article for important intellectual content (NH-N, CRB, AJS, MAA, JAC, MK and CRW); final approval of the article (NH-N, CRB, AJS, MAA, JAC, MK and CRW).

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer Unrelated to this project: Dr Carrino has received consulting fee from Pfizer, Inc, Covera, IAG, Image Biopsy Lab, and Simplify Medical, and is a member of scientific advisory board/other office of IAG. Dr Khan is consultant for Stryker Medical and Medwaves Avecure Medical Corporation. Dr Weiss has received research grants from Siemens Healthcare, Merit Medical, Medtronic, and BTG and is a consultant for BTG and Medtronic.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study uses de-identified data from the National Inpatient Sample (NIS), part of the Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality (AHRQ), United States Department of Health and Human Services. HCUP recommendations and protocols were followed throughout the study. No IRB was required/applicable.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. Data from the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality, United States Department of Health and Human Service.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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