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Trends in Inpatient Vertebroplasty and Kyphoplasty Volume in the United States, 2005-2011: Assessing the Impact of Randomized Controlled Trials.
Clin Spine Surg. 2017 04; 30(3):E276-E282.CS

Abstract

STUDY DESIGN

Retrospective analysis of the Nationwide Inpatient Sample, 2005-2011.

OBJECTIVE

To identify trends in procedural volume and rates in the time period surrounding publication of randomized controlled trials (RCTs) that examined the utility of vertebroplasty and kyphoplasty.

SUMMARY OF BACKGROUND DATA

Vertebroplasty and kyphoplasty are frequently performed for vertebral compression fractures. Several RCTs have been published with conflicting outcomes regarding pain and quality of life compared with nonsurgical management and sham procedures. Four RCTs with discordant results were published in 2009.

MATERIALS AND METHODS

The Nationwide Inpatient Sample provided longitudinal, retrospective data on United States' inpatients between 2005 and 2011. Inclusion was determined by a principal or secondary International Classification of Diseases, Ninth Revision, Clinical Modification code of 81.65 (percutaneous vertebroplasty) or 81.66 (percutaneous vertebral augmentation; "kyphoplasty"). No diagnoses were excluded. Years were stratified as "pre" (2005-2008) and "post" (2010-2011) in relation to the 4 RCTs published in 2009. Patient, hospital, and admission characteristics were compared using Pearson χ test.

RESULTS

The estimated annual inpatient procedures performed decreased from 54,833 to 39,832 in the pre and post periods, respectively. The procedural rate for fractures decreased from 20.1% to 14.7% (P<0.0001). Patient and hospital demographics did not change considerably between the time periods. In the post period, weekend admissions increased (34.2% vs. 12.4%, P<0.0001), elective admissions decreased (21.4% vs. 40.0%, P<0.0001), routine discharge decreased (33.0% vs. 52.1%, P<0.0001), and encounters with ≥3 Elixhauser comorbidities increased (54.5% vs. 39.1%, P<0.0001).

CONCLUSIONS

The absolute rate of inpatient vertebroplasty and kyphoplasty procedures for fractures decreased 5% in the period (2010-2011) following the publication of 4 RCTs in 2009. The proportion of elective admissions and routine discharges decreased, possibly indicating a population with greater disease severity. Although our analysis cannot demonstrate a cause-and-effect relationship, the decreased inpatient volume and procedural rates surrounding the publication of sentinel negative RCTs is clearly observed.

Authors+Show Affiliations

*Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, OH †Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, OR ‡Center for Spine Health §Department of Orthopaedic Surgery ∥Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

28323712

Citation

Rosenbaum, Benjamin P., et al. "Trends in Inpatient Vertebroplasty and Kyphoplasty Volume in the United States, 2005-2011: Assessing the Impact of Randomized Controlled Trials." Clinical Spine Surgery, vol. 30, no. 3, 2017, pp. E276-E282.
Rosenbaum BP, Kshettry VR, Kelly ML, et al. Trends in Inpatient Vertebroplasty and Kyphoplasty Volume in the United States, 2005-2011: Assessing the Impact of Randomized Controlled Trials. Clin Spine Surg. 2017;30(3):E276-E282.
Rosenbaum, B. P., Kshettry, V. R., Kelly, M. L., Mroz, T. E., & Weil, R. J. (2017). Trends in Inpatient Vertebroplasty and Kyphoplasty Volume in the United States, 2005-2011: Assessing the Impact of Randomized Controlled Trials. Clinical Spine Surgery, 30(3), E276-E282. https://doi.org/10.1097/BSD.0000000000000207
Rosenbaum BP, et al. Trends in Inpatient Vertebroplasty and Kyphoplasty Volume in the United States, 2005-2011: Assessing the Impact of Randomized Controlled Trials. Clin Spine Surg. 2017;30(3):E276-E282. PubMed PMID: 28323712.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Trends in Inpatient Vertebroplasty and Kyphoplasty Volume in the United States, 2005-2011: Assessing the Impact of Randomized Controlled Trials. AU - Rosenbaum,Benjamin P, AU - Kshettry,Varun R, AU - Kelly,Michael L, AU - Mroz,Thomas E, AU - Weil,Robert J, PY - 2017/3/22/entrez PY - 2017/3/23/pubmed PY - 2018/6/5/medline SP - E276 EP - E282 JF - Clinical spine surgery JO - Clin Spine Surg VL - 30 IS - 3 N2 - STUDY DESIGN: Retrospective analysis of the Nationwide Inpatient Sample, 2005-2011. OBJECTIVE: To identify trends in procedural volume and rates in the time period surrounding publication of randomized controlled trials (RCTs) that examined the utility of vertebroplasty and kyphoplasty. SUMMARY OF BACKGROUND DATA: Vertebroplasty and kyphoplasty are frequently performed for vertebral compression fractures. Several RCTs have been published with conflicting outcomes regarding pain and quality of life compared with nonsurgical management and sham procedures. Four RCTs with discordant results were published in 2009. MATERIALS AND METHODS: The Nationwide Inpatient Sample provided longitudinal, retrospective data on United States' inpatients between 2005 and 2011. Inclusion was determined by a principal or secondary International Classification of Diseases, Ninth Revision, Clinical Modification code of 81.65 (percutaneous vertebroplasty) or 81.66 (percutaneous vertebral augmentation; "kyphoplasty"). No diagnoses were excluded. Years were stratified as "pre" (2005-2008) and "post" (2010-2011) in relation to the 4 RCTs published in 2009. Patient, hospital, and admission characteristics were compared using Pearson χ test. RESULTS: The estimated annual inpatient procedures performed decreased from 54,833 to 39,832 in the pre and post periods, respectively. The procedural rate for fractures decreased from 20.1% to 14.7% (P<0.0001). Patient and hospital demographics did not change considerably between the time periods. In the post period, weekend admissions increased (34.2% vs. 12.4%, P<0.0001), elective admissions decreased (21.4% vs. 40.0%, P<0.0001), routine discharge decreased (33.0% vs. 52.1%, P<0.0001), and encounters with ≥3 Elixhauser comorbidities increased (54.5% vs. 39.1%, P<0.0001). CONCLUSIONS: The absolute rate of inpatient vertebroplasty and kyphoplasty procedures for fractures decreased 5% in the period (2010-2011) following the publication of 4 RCTs in 2009. The proportion of elective admissions and routine discharges decreased, possibly indicating a population with greater disease severity. Although our analysis cannot demonstrate a cause-and-effect relationship, the decreased inpatient volume and procedural rates surrounding the publication of sentinel negative RCTs is clearly observed. SN - 2380-0194 UR - https://www.unboundmedicine.com/medline/citation/28323712/Trends_in_Inpatient_Vertebroplasty_and_Kyphoplasty_Volume_in_the_United_States_2005_2011:_Assessing_the_Impact_of_Randomized_Controlled_Trials_ L2 - http://dx.doi.org/10.1097/BSD.0000000000000207 DB - PRIME DP - Unbound Medicine ER -