Back to Search
Start Over
Were VCF patients at higher risk of mortality following the 2009 publication of the vertebroplasty "sham" trials?
- Source :
-
Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA [Osteoporos Int] 2018 Feb; Vol. 29 (2), pp. 375-383. Date of Electronic Publication: 2017 Oct 24. - Publication Year :
- 2018
-
Abstract
- The 5-year period following 2009 saw a steep reduction in vertebral augmentation volume and was associated with elevated mortality risk in vertebral compression fracture (VCF) patients. The risk of mortality following a VCF diagnosis was 85.1% at 10 years and was found to be lower for balloon kyphoplasty (BKP) and vertebroplasty (VP) patients.<br />Introduction: BKP and VP are associated with lower mortality risks than non-surgical management (NSM) of VCF. VP versus sham trials published in 2009 sparked controversy over its effectiveness, leading to diminished referral volumes. We hypothesized that lower BKP/VP utilization would lead to a greater mortality risk for VCF patients.<br />Methods: BKP/VP utilization was evaluated for VCF patients in the 100% US Medicare data set (2005-2014). Survival and morbidity were analyzed by the Kaplan-Meier method and compared between NSM, BKP, and VP using Cox regression with adjustment by propensity score and various factors.<br />Results: The cohort included 261,756 BKP (12.6%) and 117,232 VP (5.6%) patients, comprising 20% of the VCF patient population in 2005, peaking at 24% in 2007-2008, and declining to 14% in 2014. The propensity-adjusted mortality risk for VCF patients was 4% (95% CI, 3-4%; p < 0.001) greater in 2010-2014 versus 2005-2009. The 10-year risk of mortality for the overall cohort was 85.1%. BKP and VP cohorts had a 19% (95% CI, 19-19%; p < 0.001) and 7% (95% CI, 7-8%; p < 0.001) lower propensity-adjusted 10-year mortality risk than the NSM cohort, respectively. The BKP cohort had a 13% (95% CI, 12-13%; p < 0.001) lower propensity-adjusted 10-year mortality risk than the VP cohort.<br />Conclusions: Changes in treatment patterns following the 2009 VP publications led to fewer augmentation procedures. In turn, the 5-year period following 2009 was associated with elevated mortality risk in VCF patients. This provides insight into the implications of treatment pattern changes and associated mortality risks.
- Subjects :
- Aged
Aged, 80 and over
Attitude of Health Personnel
Comorbidity
Female
Fractures, Compression surgery
Humans
Kaplan-Meier Estimate
Kyphoplasty statistics & numerical data
Length of Stay statistics & numerical data
Male
Medicare statistics & numerical data
Mortality trends
Osteoporotic Fractures surgery
Randomized Controlled Trials as Topic standards
Research Design standards
Risk Assessment methods
Spinal Fractures surgery
United States epidemiology
Fractures, Compression mortality
Osteoporotic Fractures mortality
Spinal Fractures mortality
Vertebroplasty statistics & numerical data
Subjects
Details
- Language :
- English
- ISSN :
- 1433-2965
- Volume :
- 29
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA
- Publication Type :
- Academic Journal
- Accession number :
- 29063215
- Full Text :
- https://doi.org/10.1007/s00198-017-4281-z