Enhanced Risk Stratification for Short-Term Complications Following Vertebral Augmentation for Osteoporotic Vertebral Compression Fractures

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Percentages of inpatient vs outpatient vs preprocedure hospitalized cohorts who underwent vertebral augmentations by year. From 2011 to 2014, the percentage of patients who recieved outpatient vertebral augmentation increased from 53.9% in 2011 to 64.1% in 2014. The percentage of patients who underwent the procedure as inpatients decreased from 33.3% in 2011 to 28.6% in 2014. The proportion of patients who were hospitalized before the procedure decreased from 12.8% in 2011 to 7.4% in 2014.

Table 1

Demographics of patients receiving vertebral augmentation by surgical setting.

Patient Demographic	Cohorts			Comparison P Values
Patient Demographic	Outpatient	Inpatient	Preprocedure Hospitalization	Outpatient vs Inpatient	Outpatient vs Preprocedure Hospitalization
Total, n (%)	1023 (61.1%)	503 (30.0%)	149 (8.9%)
Age, y, mean (SD)	74.0 (12.1)	75.9 (10.3)	79.6 (10.5)
Sex, %				0.181	0.341
Female	68.6	72.0	72.5
Male	31.4	28.0	27.5
Race, %				0.089	0.355
American Indian or Alaska Native	0.1	0.4	0.7
Asian	5.3	2.4	2.7
Black or African American	1.8	1.0	2.0
Native Hawaiian, Pacific Islander	0.2	0.0	0.0
White	88.1	91.7	88.6
Unknown	4.6	4.6	6.0
Body mass index, %				0.047	0.250
Underweight (<18.5 kg/m²)	6.1	3.2	4.7
Nonobese (18.5–29.9 kg/m²)	71.8	75.4	77.9
Obese I (30.0–34.9 kg/m²)	14.9	13.9	9.4
Obese II (35.0–39.9 kg/m²)	5.5	4.4	4.7
Obese III (≥40 kg/m²)	1.9	3.2	3.4
Functional status before surgery, %				0.122	<0.001
Independent in ADL	90.0	87.3	66.4
Partially/totally dependent in ADL	6.3	9.2	31.5
Unknown	3.7	3.6	2.0

Table 2

Comorbidities and operative variables by surgical setting.

Comorbidity	Cohorts			Comparison P Values
Comorbidity	Outpatient	Inpatient	Preprocedure Hospitalization	Outpatient vs Inpatient	Outpatient vs Preprocedure Hospitalization
Total, n (%)	1023 (61.1%)	503 (30.0%)	149 (8.9%)
Cardiovascular, %
Congestive heart failure	1.08	0.99	2.68	0.884	0.103
Myocardial infarction	0	0.20	0	0.345	0.499
Previous percutaneous coronary intervention	1.27	0.99	1.34	0.894	0.786
Previous cardiac surgery	0.98	0.99	0.67	0.977	0.673
Angina	0.20	0	0	0.609	0.654
Hypertension requiring medication	62.07	64.02	73.83	0.461	0.005
Peripheral vascular disease	0.20	0.60	0.67	0.399	0.490
Pulmonary, %
Current smoker	13.59	10.54	13.42	0.091	0.956
Dyspnea	11.24	13.92	12.75	0.132	0.588
Chronic obstructive pulmonary disorder	10.56	14.51	20.81	0.025	0.000
Renal, %
Currently on dialysis	0.78	0.20	1.34	0.162	0.487
Cerebrovascular, %
Stroke with neurologic deficits	0.20	0.40	0.00	0.732	0.654
Stroke with no neurologic deficits	0.68	0	0.67	0.175	0.782
Transient ischemic attacks	0.78	0.20	0.67	0.373	0.754
Other, %
Weight loss, unintentional	0.68	1.19	0.67	0.310	0.986
Diabetes	14.96	16.30	16.78	0.399	0.093
Alcohol use	0.68	0.20	0	0.466	0.389
Chronic corticosteroid use	9.19	10.54	13.42	0.401	0.103
Procedure type, %
Kyphoplasty	90.81	90.85	89.93	0.978	0.730
Vertebroplasty	9.19	9.15	10.07	0.978	0.730
American Society of Anesthesiologists class, %				0.005	<0.001
1—A normal healthy patient	1.17	0.60	0.67
2—A patient with mild systemic disease	32.75	24.65	9.40
3—A patient with severe systemic disease	59.82	68.79	64.43
4—A patient with life-threatening disease	6.26	5.96	25.50

Table 3

Short-term postoperative outcomes by surgical setting.

Outcome	Cohorts			Comparison P Values
Outcome	Outpatient	Inpatient	Preprocedure Hospitalization	Outpatient vs Inpatient	Outpatient vs Preprocedure Hospitalized
Total, n (%)	1023 (61.1%)	503 (30.0%)	149 (8.9%)
Mortality, %	0.68	0.60	2.68	0.842	0.018
Sepsis, %	0.10	1.19	1.34	0.0029	0.005
Cardiovascular, %
Myocardial infarction	0	0.40	0	0.044	N/A
Pulmonary, %
Unplanned intubation	0.10	0.20	0.67	0.608	0.113
Pneumonia	0.20	0.60	4.03	0.198	<0.001
Renal, %
Acute renal failure	0.10	0.20	0.67	0.608	0.113
Progressive renal insufficiency	0	0.20	0	0.154	N/A
Hospital-acquired conditions, %
Wound infection	0.10	0	0	0.483	0.703
Wound dehiscence	0.10	0	0	0.483	0.703
Urinary tract infection	0.98	1.99	4.03	0.103	0.003
Deep venous thrombosis	0.10	0	0.67	0.483	0.113
Pulmonary embolism	0.29	0.40	0	0.737	0.508
Other, %
Transfusion, perioperative	0	0.60	0.67	0.013	0.009
Readmission	6.26	6.76	12.08	0.706	0.009
Reoperation	2.93	3.18	1.34	0.790	0.266
Discharge destination, %				<0.001	<0.001
Home	99.32	93.44	59.73
Facility	0.59	5.77	40.27
Unknown	0.10	0.80	0

Table 4

Evaluation of surgical setting as a risk factor for selected postoperative complications.

Surgical Setting	OR	Lower 95% CI	Upper 95% CI	P Value
	Mortality
Inpatient vs outpatient	1.11	0.27	4.52	0.343
Preprocedure hospitalized vs outpatient	4.49	1.22	16.53	0.024
Preprocedure hospitalized vs inpatient	4.78	0.99	23.22	0.052
	Pneumonia
Inpatient vs outpatient	2.77	0.45	17.00	0.513
Preprocedure hospitalized vs outpatient	19.69	3.81	101.65	<0.001
Preprocedure hospitalized vs inpatient	7.22	1.70	30.69	0.007
	Urinary Tract Infection
Inpatient vs outpatient	1.93	0.79	4.70	0.934
Preprocedure hospitalized vs outpatient	3.98	1.41	11.20	0.028
Preprocedure hospitalized vs inpatient	1.98	0.68	5.73	0.211
	Readmission
Inpatient vs outpatient	1.05	0.68	1.62	0.255
Preprocedure hospitalized vs outpatient	1.86	1.06	3.26	0.032
Preprocedure hospitalized vs inpatient	1.83	0.99	3.36	0.053