Clinical Study Vertebroplasty and kyphoplasty: national outcomes and trends in utilization from 2005 through 2010 Vadim Goz, BA a,b , Thomas J. Errico, MD b , Jeffrey H. Weinreb, BS b , Steven M. Koehler, MD a , Andrew C. Hecht, MD a , Virginie Lafage, PhD b , Sheeraz A. Qureshi, MD, MBA a, * a Department of Orthopaedic Surgery, The Mount Sinai Medical Center, 5 E 98th St, 9th Floor, New York, NY 10029, USA b Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, 301 E 17th St, New York, NY 10003, USA Received 12 February 2013; revised 24 May 2013; accepted 14 June 2013 Abstract BACKGROUND CONTEXT: Vertebral compression fractures secondary to low bone mass are responsible for almost 130,000 inpatient admissions and 133,500 emergency department visits an- nually, totaling over $5 billion of direct inpatient costs. Although most vertebral compression frac- tures heal within a few months with conservative therapy, a significant portion fail to improve with conservative treatment and require long-term care, conservative treatment, or both. Fractures that fail conservative therapy are treated with vertebral augmentation procedures (VAPs) such as verte- broplasty (VP) and kyphoplasty (KP). Two large randomized clinical trials published in 2009 ques- tioned the efficacy of VP in treatment of VAPs. PURPOSE: This study aimed to investigate trends in utilization of VP and KP between 2005 and 2010 to capture the impact of the 2009 literature on utilization of VAPs. The study also compares patient characteristics and perioperative outcomes between VP and KP to further delineate the risks of each procedure. STUDY DESIGN: Retrospective analysis of national utilization rates, clinical outcomes, patient demographics, and patient comorbidities using a large national inpatient database. PATIENT SAMPLE: A total of 63,459 inpatient admissions from 46 states and more than 1,000 different hospitals were included in the analysis. OUTCOME MEASURES: Length of stay (LOS), total direct cost, mortality, postoperative complications. METHODS: Data were obtained from the National Inpatient Sample database for the period be- tween 2005 and 2010. National Inpatient Sample is the largest publicly available all payer inpatient database in the United States. Patients undergoing VP and KP were identified via corresponding the International Classification of Diseases, 9th Revision procedure codes. National utilization trends were estimated using weights supplied as part of the National Inpatient Sample dataset. Information on patient comorbidities and demographics was collected. A series of univariate and multivarariate analyses were used to identify statistically significant differences in patient characteristics, clinical outcomes, as well as cost and LOS between patients undergoing VP versus KP. RESULTS: A total of 307,050 inpatient VAPs were performed in the United States between 2005 and 2010. Of those procedures, 225,259 were KP and 81,790 were VP. Kyphoplasty utilization showed an increasing trend between 2005 and 2007, increasing from 27 to 33 procedures per 100,000 capita older than 40 years. During the same time period, VP utilization remained constant at approximately nine procedures per 100,000 capita older than 40 years. After 2007, utilization of FDA device/drug status: Not applicable. Author disclosures: VG: Nothing to disclose. TJE: Royalties: K2M (F), Fastenetix (F); Research Support (Investigator Salary, Staff/Materials): Paradigm Spine (F, Paid directly to institution/employer); Grant: Fridolin (E, Paid directly to institution/employer); Fellowship Support: OREF (E, Paid directly to institution/employer), OMEGA (E, Paid directly to institu- tion/employer), AO Spine (E, Paid directly to institution/employer). JHW: Nothing to disclose. SMK: Nothing to disclose. ACH: Royalties: Zimmer (C); Consulting: Zimmer (B), Medtronic, Stryker, Depuy (B). VL: Stock Ownership: Nemaris Inc (22.73% ownership); Consulting: Medtronic (B); Speaking/Teaching Arrangements: Medtronic (D), DepuySpine (D), K2M (D); Grant: SRS (D, Paid directly to institution/employer). SAQ: Royalties: Zimmer (B); Consulting: Stryker (B), Medtronic (B), Orthofix (B), Zimmer (B); Board of Directors: MTF (B); Scientific Advisory Board/Other Office: Zimmer (B); Grant: CSRS (B, Paid directly to institu- tion/employer). The disclosure key can be found on the Table of Contents and at www. TheSpineJournalOnline.com. * Corresponding author. Department of Orthopaedic Surgery, Mount Sinai Medical Center, 5 E. 98th St, 9th Floor, New York, NY 10029, USA. Tel.: (212)-241-3909 E-mail address: Sheeraz.Qureshi@mountsinai.org (S.A. Qureshi) 1529-9430/$ - see front matter Ó 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.spinee.2013.06.032 The Spine Journal - (2013) -