Real-world rates and risk factors for subsequent treatment with vertebroplasty or balloon kyphoplasty after initial vertebral augmentation: a retrospective cohort study

被引:0
作者
Hirsch, Joshua A. [1 ,2 ,8 ]
Gilligan, Christopher [3 ]
Chandra, Ronil V. [4 ,5 ]
Brook, Allan [6 ]
Gasquet, Nicolas C. [7 ]
Ricker, Christine N. [7 ]
Wu, Charlotte [7 ]
机构
[1] Massachusetts Gen Hosp, Dept Intervent Neuroradiol, Boston, MA 02114 USA
[2] Harvard Med Sch, Boston, MA 02114 USA
[3] Robert Wood Johnson Univ Hosp, New Brunswick, NJ USA
[4] Monash Med Ctr, Dept Intervent Neuroradiol, Melbourne, Australia
[5] Monash Univ, Melbourne, Australia
[6] Montefiore Med Ctr, Dept Radiol, Bronx, NY USA
[7] Medtron Plc, Minneapolis, MN USA
[8] Massachusetts Gen Hosp, Dept Radiol, Boston, MA 02114 USA
关键词
Balloon kyphoplasty; Osteoporosis; Subsequent fracture; Vertebral augmentation; Vertebral compression fracture; Vertebroplasty; COMPRESSION FRACTURES; RANDOMIZED-TRIAL; CEMENT LEAKAGE; TASK-FORCE; MANAGEMENT; OUTCOMES; SAFETY;
D O I
10.1007/s00198-024-07294-z
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
The purpose of this study was to determine the real-world incidence and predictors of additional vertebroplasty or balloon kyphoplasty after initial vertebral augmentation, as a proxy for subsequent symptomatic vertebral fracture. Of patients, 15.5% underwent subsequent vertebral augmentation. The patient's comorbidities are strongly associated with risk of subsequent treatment. Purpose To determine the real-world incidence and predictors of additional vertebroplasty or balloon kyphoplasty after initial vertebral augmentation, as a proxy for subsequent symptomatic and disabling vertebral fracture. MethodsWe conducted a retrospective cohort study using commercial insurance claims data (Optum's de-identified Clinformatics (R) Data Mart Database). Adult patients who underwent subsequent treatment for vertebral fracture within 24 months of initial balloon kyphoplasty (BKP) or vertebroplasty (VP) were classified into "subsequent treatment" or "no subsequent treatment" cohorts. Survival analysis was applied to investigate the effect of risk factors on subsequent treatment. Results Between 1 January 2008 and 30 June 2020, a total of 32,513 adult patients underwent a BKP/VP procedure following a diagnosis of vertebral compression fracture in the preceding 12 months. Five thousand thirty-five patients (15.5%) underwent a subsequent BKP/VP treatment within 2 years; 90% had a single fracture level treated. An increased hazard of subsequent treatment was associated with a number of fractures treated at initial BKP/VP (>= 4 levels, adjusted hazard ratio (AHR) 1.68 (95% CI 1.24-2.26); steroid use, AHR 1.9 (95% CI 1.31-1.48); Elixhauser Comorbidity Index >= 4, AHR 1.44 (95% CI 1.17-1.77); and multiple myeloma, AHR 1.31 (95% CI 1.13-1.53)). Age < 70 years was associated with reduced hazard of subsequent treatment (AHR 0.81, 95% CI 0.74-0.89). Conclusions One in seven patients underwent subsequent treatment for vertebral fracture after initial vertebral augmentation. Baseline patient characteristics were associated with increased risk of subsequent fracture within 2 years, suggesting that a patient's natural history is strongly associated with risk of subsequent treatment rather than the initial surgical procedure itself.
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页码:129 / 140
页数:12
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