Kyphoplasty for Elderly Patients With Vertebral Compression Fractures—Do We Save Lives? Mortality Rates Analysis Comparison in a Long-Term Follow-Up Cohort

Abstract

Study Design: Retrospective cohort. Objectives: We aimed to compare a large cohort of patients with vertebral compression fractures (VCF) treated in 2 centers using different protocols (conservative vs BKP) and compare mortality rates on a long-term follow-up. Methods: Retrospective cohort held in 2 medical centers (W and AH). All patients admitted with VCF from November 2008 to January 2015 were enrolled in the study. Exclusion criteria were patients admitted with non-osteoporotic pathological fractures (such as metastatic or MM). Results: Our study included 208 patients treated for VCF, 127 were treated with BKP (88 females, 69.3%) and 81 were treated conservatively (59 females, 72.8%). Patients from Centre W were older and frailer compared to the patients from AH center (Average age 75.12 ± 11.16 vs 69.13 ± 9.61 years and Frailty score of 0.16 ± 0.1 vs 0.12 ± 0.1 respectively, T-test, p < 0.01 for both). Hazard ratios (HR) for age, female gender and frailty were significant for increased mortality, frailty had the highest HR of 182.42 (CI 29.05-1145.33, p < 0.01). Multivariate Cox model was fitted and after accounting for Gender, Age and Frailty, no significant difference was found between the 2 medical centers mortality rates (p = 0.59), thus no difference in mortality rates between BKP and conservative treatment in our study. Conclusion: long-term follow-up following BKP treatment for VCF did not show a reduced mortality rate compared to conservative treatment after accounting for frailty, age and gender. Frailty was the most important factor in predicting mortality. Further RCTs are needed to compare the quality of life differences between the 2 treatment strategies.