Single-Level Vertebral Augmentation Procedures: Vertebroplasty Use Fading Relative to Kyphoplasty Over the Years 2010 to 2021.

Abstract

A retrospective cohort study using the large, national, multi-insurance, 2010-2021 M161 PearlDiver administrative data set. The current study aimed to characterize trends in use, predictive factors, and 90-day overall care reimbursements for single-level kyphoplasty relative to vertebroplasty from 2010 to 2021. Vertebral augmentation procedures, including kyphoplasty and vertebroplasty, may be considered in the management of vertebral compression fractures. While these procedures are often studied together, literature on comparative trends, utilization, and costs is limited. Single-level kyphoplasty and vertebroplasty cases were identified. Total numerical and proportional utilization were assessed over the study interval as well as physician specialties performing these procedures. Univariate and multivariate analyses were performed to identify factors for having kyphoplasty relative to vertebroplasty. From 2010 through 2021, 135,840 kyphoplasties and 31,891 vertebroplasties were identified. The proportional use of kyphoplasty compared with vertebroplasty rose from 69.79% to 87.55% (P<0.001). Independent predictors of having kyphoplasty relative to vertebroplasty included: age [per decade increase odds ratio [OR] 1.004], higher ECI (relative to 0, incrementally greater for ECI 1-2, OR: 1.282, ECI: 3-4, OR: 1.413, and ECI ≥5 OR: 1.514), insurance plan (relative to commercial, Medicare OR 0.968, Medicaid OR 0.926), and geographic variation (compared with Midwest, West OR 1.239, South OR 1.984, and Northeast OR 1.800) (P<0.05 for all).The physician specialty performing the most kyphoplasties varied over the years, but radiologists consistently performed most vertebroplasties. There was an increasing trend in nonsurgical specialties performing vertebral augmentations (39.6% vs. 54.2%, P<0.001). There was an increase in utilization of kyphoplasty relative to vertebroplasty over the years of the study (69.79% in 2010 evolved to 87.55% in 2021). Variations in use were associated with both clinical and nonclinical factors. Given similar overall 90-day health care costs/reimbursements, evolving to best practices appears indicated.