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Evaluating the Complication Profile of Inpatient, Outpatient ASC, and Office-Based Percutaneous Kyphoplasty for
Manjot Singh1, Trevor L Toavs, Claire Lin
1From the Warren Alpert Medical School (Singh, Toavs, Lin, Nassar, Farias), Brown University, Providence, RI, and the Department of Orthopedics (Tian, Diebo, Daniels), Brown University, Providence, RI.
Background:
Percutaneous kyphoplasty is routinely indicated in elderly patients with osteoporotic vertebral compression fractures (VCFs) who have failed conservative management. Although it can effectively stabilize the vertebra and alleviate pain, kyphoplasty has been associated with various complications, including pulmonary embolism and adjacent level fractures. However, there is a lack of consensus on whether office-based kyphoplasty is safer than inpatient or outpatient ambulatory surgery center (outpatient-ASC)-based kyphoplasty.
Methods:
PearlDiver was queried to identify adults undergoing percutaneous kyphoplasty for new age-related osteoporotic VCF between 2016 to 2022. Patients were stratified by service location (ie, inpatient, outpatient-ASC, outpatient office) and matched 1:1 by age, sex, and Charlson Comorbidity Index. Medical complications 90 days after the procedure were compared.
Results:
In total, 71,084 patients underwent kyphoplasty for osteoporotic VCFs between 2016 to 2022. The mean age was 74.3 years, 76.2% were female, and mean Charlson Comorbidity Index was 3.5. The proportion of annual kyphoplasty cases performed in the outpatient-office setting increased markedly from 21.7% in 2016 to 29.6% in 2022 ( P = 0.002). After matching, 11,340 patients remained in each cohort. Multivariate logistic regression analyses revealed that the inpatient cohort had the highest odds of acute kidney injury, cardiac arrest, deep vein thrombosis, pneumonia, transfusion, urinary tract infection, site complications, wound complications, and readmissions (all P < 0.004). Both the inpatient and the outpatient-ASC cohorts had higher odds of infection than the outpatient-office cohort ( P < 0.001). Finally, the outpatient-office cohort had the highest odds of nerve injury and secondary fractures ( P < 0.004).
Discussion:
In this retrospective cohort study of kyphoplasty performed for osteoporotic VCFs, office-based kyphoplasty procedures were observed to have a lower rate of medical complications compared with inpatient or outpatient-ASC-based kyphoplasty procedures. These findings suggest that office-based kyphoplasty may represent an appropriate treatment setting for carefully selected patients with osteoporotic VCFs.