Acute Operative Management of Osteoporotic Vertebral Compression Fractures Is Associated with Decreased Morbidity

STUDY DESIGN: Retrospective national database study design. PURPOSE: This study was designed to determine whether acute percutaneous vertebral augmentation (PVA) alters morbidity compared with nonoperative management. OVERVIEW OF LITERATURE: Osteoporotic vertebral compression fractures (OCFs) are common and represent a large economic and patient burden. Several recent studies have focused on whether PVA offers benefits compared with nonoperative treatment. METHODS: A retrospective cohort analysis was conducted using the Nationwide Inpatient Sample from 2015 to 2018. Patients with nonelective admissions for OCFs were identified using International Classification of Diseases (10th edition) codes. The exclusion criteria included age of less than 50 years, fusion and decompression procedures, and the presence of neoplasms and infections. Propensity score matching was implemented to construct 2:1 matched cohorts with similar comorbidities at admission. The patients were divided into the operative and nonoperative treatment groups. Univariate and multivariate regression analyses were performed to compare differences in in-hospital complication rates between the groups. All p-values of less than 0.05 were considered significant. RESULTS: We identified 14,850 patients in the operative group and 29,700 patients in the nonoperative group. In the multivariate analysis, operative treatment was associated with significantly lower rates of pneumonia (odds ratio [OR], 0.75; p<0.001), acute respiratory failure (OR, 0.84; p=0.009), myocardial infarction (OR, 0.20; p<0.001), acute heart failure (OR, 0.80; p=0.001), cardiogenic shock (OR, 0.23; p=0.001), sepsis (OR, 0.39; p<0.001), septic shock (OR 0.50; p<0.001), and pressure ulcerations (OR, 0.71; p<0.001). However, operative treatment was associated with a significantly greater risk of acute renal failure (OR, 1.19; p<0.001) than nonoperative treatment. CONCLUSIONS: Patients who undergo acute PVA for OCFs have lower rates of respiratory complications, cardiac complications, sepsis, and pressure ulcerations while having a higher risk of acute renal failure.