Table 4.
Comparison of patients who received kyphoplasty to propensity matched patients who did not receive augmentation. Exact match on opioids, advanced imaging, and diagnoses of complications between fracture and kyphoplasty/pseudo-kyphoplasty (control group 3)
| Variable | No Augmentation n = 26,282 (50%) n (%) |
Kyphoplasty n = 26,282 (50%) n (%) |
Total n = 52,564 |
|---|---|---|---|
| Age (Median, IQR) | 78.9 (72.8, 85.7) | 80.5 (74.5, 86.4) | 79.8 (73.6, 86.1) |
| Female | 22,506 (86) | 21,801 (83) | 44,307 (84) |
| Patient race | |||
| Unknown | 237 (1) | 157 (1) | 394 (1) |
| White | 24,214 (92) | 24,384 (93) | 48,598 (92) |
| Black | 365 (1) | 397 (2) | 762 (1) |
| Other | 386 (1) | 317 (1) | 703 (1) |
| Asian | 614 (2) | 571 (2) | 1185 (2) |
| Hispanic | 390 (1) | 367 (1) | 757 (1) |
| North American Native | 76 (0) | 89 (0) | 165 (0) |
| Year of Fracture | |||
| 2017 | 6249 (24) | 9673 (37) | 15,922 (30) |
| 2018 | 8321 (32) | 8823 (34) | 17,144 (33) |
| 2019 | 11,712 (45) | 7786 (30) | 19,498 (37) |
| Charlson Co-morbidity Score (Median, IQR) | 1 (0, 3) | 2 (1, 3) | 1 (0, 3) |
| 0 | 8772 (33) | 6459 (25) | 15,231 (29) |
| 1 | 6773 (26) | 6361 (24) | 13,134 (25) |
| 2–3 | 6873 (26) | 7812 (30) | 14,685 (28) |
| 4–5 | 2608 (10) | 3477 (13) | 6085 (12) |
| 6 + | 1256 (5) | 2173 (8) | 3429 (7) |
| Comorbidities in year prior to fracture | |||
| Congestive heart failure | 4381 (17) | 6198 (24) | 10,579 (20) |
| Dementia | 2411 (9) | 2979 (11) | 5390 (10) |
| Renal failure | 3417 (13) | 4597 (17) | 8014 (15) |
| Weight loss | 1356 (5) | 2016 (8) | 3372 (6) |
| Hemiplegia | 153 (1) | 275 (1) | 428 (1) |
| Alcohol abuse | 60 (0) | 108 (0) | 168 (0) |
| Cardiac arrhythmias | 7902 (30) | 9732 (37) | 17,634 (34) |
| Chronic pulmonary disease | 6690 (25) | 8596 (33) | 15,286 (29) |
| Coagulopathy | 624 (2) | 1164 (4) | 1788 (3) |
| Complicated diabetes | 3385 (13) | 4122 (16) | 7507 (14) |
| Deficiency anemia | 5474 (21) | 6874 (26) | 12,348 (23) |
| Fluid/electrolyte disorders | 3659 (14) | 5390 (21) | 9049 (17) |
| Liver disease | 866 (3) | 1386 (5) | 2252 (4) |
| Peripheral vascular disease | 5373 (20) | 6521 (25) | 11,894 (23) |
| Mood disorders | 5075 (19) | 5765 (22) | 10,840 (21) |
| Pulmonary circulation disorders | 1092 (4) | 1676 (6) | 2768 (5) |
| HIV/AIDS | 0 | 12 (0) | 12 (0) |
| Hypertension | 18,605 (71) | 20,128 (77) | 38,733 (74) |
| Myocardial infarction | 797 (3) | 1163 (4) | 1960 (4) |
| Cardiovascular disease | 3926 (15) | 5148 (20) | 9074 (17) |
| Rheumatic disease | 2307 (9) | 2447 (9) | 4754 (9) |
| Peptic ulcer disease | 447 (2) | 608 (2) | 1055 (2) |
| Diabetes without complications | 5274 (20) | 6280 (24) | 11,554 (22) |
| Frailty Score a | 7.5 (3.8, 12.9) | 8.9 (4.6, 15.3) | 8.2 (4.1, 14.1) |
| Intermediate/High Frail Score | 17,490 (67) | 19,068 (73) | 36,558 (70) |
| Admitted for fracture | 4766 (18) | 5127 (20) | 9893 (19) |
| Filled ≥ 1 medication from 90 days prior—fracture date | |||
| Opioid | 8813 (34) | 9571 (36) | 18,384 (35) |
| Muscle relaxer | 3328 (13) | 3182 (12) | 6510 (12) |
| Gabapentin | 1642 (6) | 1837 (7) | 3479 (7) |
| Benzodiazepine | 2677 (10) | 3054 (12) | 5731 (11) |
| NSAID | 2276 (9) | 2115 (8) | 4391 (8) |
| Pregabalin | 1788 (7) | 2088 (8) | 3876 (7) |
| Inpatient encounters in year prior to fracture (Median, IQR) | 0 (0, 0) | 0 (0, 1) | 0 (0, 0.5) |
| Outpatient encounters in year prior to fracture (Median, IQR) | 4 (1, 9) | 5 (2, 10) | 4 (2, 9) |
| Fracture Level | |||
| Lumbar | 13,267 (50) | 12,187 (46) | 25,454 (48) |
| Thoracic | 8521 (32) | 8903 (34) | 17,424 (33) |
| Thoracolumbar or Unspecified | 4494 (17) | 5192 (20) | 9686 (18) |
| Patient had buy-in from state b | 4078 (17) | 4327 (16) | 8405 (16) |
| Received advanced imaging in from 6 weeks prior to fracture through kyphoplasty/pseudo-kyphoplasty | 24,184 (92) | 24,184 (92) | 48,368 (92) |
| Filled prescription for opioid from fracture to kyphoplasty/pseudo-kyphoplasty | 8321 (32) | 8321 (32) | 16,642 (32) |
| Complications between index fracture and kyphoplasty/ pseudo-kyphoplasty | |||
| Cardiac arrest | 0 | 0 | 0 |
| Acute myocardial infarction | 31 (0) | 31 (0) | 62 (0) |
| Respiratory failure | 23 (0) | 23 (0) | 46 (0) |
| Pulmonary embolism | 23 (0) | 23 (0) | 46 (0) |
| Pneumonia | 283 (1) | 283 (1) | 566 (1) |
| Stroke | 141 (1) | 141 (1) | 282 (1) |
| CPR | 0 | 0 | 0 |
| Intubation | 0 | 0 | 0 |
| Ventilator | 0 | 0 | 0 |
| Deep vein thrombosis | 37 (0) | 37 (0) | 74 (0) |
| Hip fracture | 116 (0) | 116 (0) | 232 (0) |
| Paralysis | 18 (0) | 18 (0) | 36 (0) |
| Weight Loss | 416 (2) | 416 (2) | 832 (2) |
| Liver Disease | 225 (1) | 225 (1) | 450 (1) |
| HIV/AIDS | 0 | 0 | 0 |
| Coagulopathy | 194 (1) | 194 (1) | 388 (1) |
| Fluid and electrolyte disorders | 2568 (10) | 2568 (10) | 5136 (10) |
| Sepsis | 57 (0) | 57 (0) | 114 (0) |
| Gastrointestinal bleed | 43 (0) | 43 (0) | 86 (0) |
| Any complication | 3619 (14) | 3619 (14) | 7238 (14) |
| Days from fracture to kyphoplasty (Median, IQR) | – | 12 (4, 29) | 12 (4, 29) |
| Days of follow-up after kyphoplasty/pseudo-kyphoplasty (Median, IQR) | 341 (142, 629) | 478 (229, 755) | 408 (178, 698) |
| Death prior to matched pair receiving kyphoplasty | 0 | – | 0 |
a
Frail score derived from Gilbert et al.[23]
b
Patients whose states (including state Medicaid programs) paid their monthly premiums
HIV/AIDS Human immunodeficiency virus/acquired immunodeficiency syndrome, IQR Interquartile range, NSAID Non-steroidal anti-inflammatory drug