JAAOS - 2026-07-21 - Journal Article
Evaluating the Complication Profile of Inpatient, Outpatient ASC, and Office-Based Percutaneous Kyphoplasty for Osteoporotic Vertebral Compression Fractures.
Singh M, Toavs TL, Lin C, Nassar JE, Farias MJ, Tian S, Diebo BG, Daniels AH
Topics
Key Takeaway
Office-based kyphoplasty had lower rates of most medical complications versus inpatient and outpatient-ASC settings, but carried the highest odds of nerve injury and secondary fractures in a matched cohort of 71,084 patients.
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Summary
This study used PearlDiver to compare 90-day complication profiles of kyphoplasty performed in inpatient, outpatient-ASC, and outpatient-office settings for osteoporotic VCFs from 2016–2022, with 1:1 matching by age, sex, and CCI. Inpatient cases had the highest odds of AKI, cardiac arrest, DVT, pneumonia, transfusion, UTI, wound complications, and readmission (all P<0.004). Office-based cases had the lowest medical complication burden but the highest odds of nerve injury and secondary fractures (P<0.004), and office-based volume grew from 21.7% to 29.6% of annual cases over the study period.
Key Limitation
Claims-based data cannot distinguish whether higher nerve injury and secondary fracture rates in the office setting reflect true procedural risk or systematic selection of more complex fracture patterns routed to that setting.
Original Abstract
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.