Vertebral augmentation versus conservative therapy for emergently admitted vertebral compression deformities: An economic analysis

Background: Vertebral augmentation (VA) performed on inpatients with painful osteoporotic vertebral compression fractures (VCFs) has been shown to facilitate discharge, decrease analgesic requirements, and improve pain. Objective: The purpose of our study was to compare the overall cost, length of stay, and readmission data for patients hospitalized with painful osteoporotic VCFs, treated either medically or with inpatient VA. Setting: A single academic medical center. Study Design: Economic analysis Methods: Patients admitted with VCF over a 30-month period were identified using ICD-9 codes. The total length of stay, hospitalization costs, average daily cost, and 30-day readmission rates were compared between those who underwent VA and those managed nonoperatively. A subgroup analysis was performed with an age matched group of controls as well. Two-tailed t-tests were used for statistical significance. Results: Thirty-nine inpatients underwent VA; 61 levels were augmented. Their average age was 81.7 years. There were 209 patients who were treated nonoperatively for VCF. Their average age was 72.7 years, a significant age difference from the VA group (P < 0.01). The VA patients' average length of stay was 13.8 days, compared to 8.1 days in the medically managed group (P < 0.01). Average total costs were $26,074 in the VA group and $15,507 in the medically managed group (P < 0.01). The daily costs of admission were $2,040 in the VA group and $2,069 in the medically managed group (P = 0.85). The readmission rates related to VCF were 0% in the VA group; 5.2% in the medically managed group; and 7.7% in the agematched control group. Of those who underwent VA, 43% experienced delays in care related to anticoagulation or medical comorbidities. Limitations: The study is retrospective and uses billing data as a marker for total cost of care, The study does not account for cost differences between vertebroplasty and kyphoplasty. Conclusion: Inpatient VA can be cost effective as demonstrated by the same daily cost between the VA and medically managed groups. Early identification and consultation can facilitate VA and rapid discharge. Anticoagulation issues and medical comorbidities can delay VA and lengthen hospital stays. Hospital admitted patients with painful osteoporotic VCF who are managed conservatively and discharged are at risk for readmission.