Trends in pathological vertebral fractures in the United States: 1993 to 2004

Object. Pathological vertebral fractures (PVFs) are an increasingly important cause of disability and have many clinical and economic implications. The authors examined trends in epidemiology and surgical management of pathological vertebral fractures in the US between 1993 and 2004. Methods. The Nationwide Inpatient Sample database was used to analyze data collected from 1993 through 2004 to determine general trends in PVFs. Patients with PVFs were identified using the appropriate International Classification of Diseases, 9(th) Revision (ICD-9) diagnostic code (ICD-9 733.13). Trends in vertebral augmentation procedures and spinal fusions as well as comparison with incidences of other major pathological fractures, such as hip and upper limb, were also examined. Results. In 2004, there were more than 55,000 inpatient admissions for PVFs. The majority of patients admitted were women (78%) in the 65 to 84 year-age group (60%). Medicare accounted for greater than 80% of insurance, and nearly 50% of all patients were admitted from the emergency department. The mean duration of hospitalization has continued to decrease, from 8.1 days in 1993 to 5.4 days in 2004. The mortality rate has remained relatively constant at approximately 1.5%. The discharge disposition has continued to change with an increasing number of patients being discharged to other institutions such as nursing homes and rehabilitation facilities. There was a staggering increase in the number of vertebral augmentation procedures performed between 1993 and 2004. The "national bill" for inpatient hospitalizations for PVFs totaled $1.3 billion in 2004. Conclusions. With the continued aging of the population, PVFs represent an important cause of disability and a significant source of healthcare resource utilization.