Objective: Vertebral compression fractures (VCFs) are associated with significant pain and disability. The current standard of care is expectant medical management; however, there is emerging data encouraging the use of early kyphoplasty or vertebroplasty. The goal of this nationwide study was to investigate the outcomes of patients with acute thoracolumbar VCF who undergo very early (inpatient) kyphoplasty compared with those managed medically.
Methods: This was a retrospective cohort analysis of the Nationwide Readmissions Database from 2016 to 2022. Adult patients admitted nonelectively for thoracolumbar wedge compression fractures were included. Patients were excluded if they had cancer, additional fractures, cord compression, or if they underwent surgery. Those who underwent kyphoplasty or vertebroplasty were 1:1 propensity score matched with those who were managed medically, and Poisson or logistic regression analyses were performed for outcomes. The primary endpoint was discharge to home. Other outcomes included in-hospital death, hospital length of stay (LOS), cost, and major morbidity or mortality after discharge at 180 days.
Results: A total of 69,722 patients were included in the study, of whom 53,142 (76.2%) underwent medical management while 16,580 (23.8%) underwent kyphoplasty or vertebroplasty. After propensity score matching, patients who underwent kyphoplasty/vertebroplasty experienced a significantly higher rate of discharge to home (54.3%) compared with medically managed patients (46.2%) (OR 1.38, 95% CI 1.28-1.50; p < 0.001). Compared with medical management, patients who underwent kyphoplasty/vertebroplasty had significantly lower in-hospital death (0.4% vs 0.9%; OR 0.48, 95% CI 0.32-0.74; p < 0.001) but a slightly longer hospital LOS (median 5 vs 4 days; B = 1.23, 95% CI 1.07-1.38; p < 0.001) and higher cost (B = 8.9, 95% CI 8.4-9.3; p < 0.001). There was no significant difference in inpatient adverse events between the medical management and kyphoplasty/vertebroplasty groups (p > 0.05), and, among patients discharged home, inpatient kyphoplasty/vertebroplasty did not lead to differences in delayed morbidity or mortality within 180 days (p > 0.05). Subgroup analysis revealed that women may derive a greater benefit from kyphoplasty/vertebroplasty (OR 1.47, 95% CI 1.35-1.61; p < 0.001) than men (OR 1.19, 95% CI 1.05-1.35; p = 0.009) (interaction p = 0.003).
Conclusions: Inpatient kyphoplasty/vertebroplasty is associated with higher odds of home discharge and lower odds of mortality. These findings support the use of very early (inpatient) kyphoplasty/vertebroplasty for those with acute thoracolumbar compression fractures.
Keywords: complications; compression fracture; inpatient; kyphoplasty/vertebroplasty; outcomes; readmission; surgical technique.