P116. Comparing short term complications of inpatient versus outpatient elective vertebral augmentation for osteoporotic vertebral compression fractures

BACKGROUND CONTEXT For elderly patients with unremitting back pain secondary to osteoporotic vertebral compression fractures (VCF), vertebral augmentation remains the most utilized surgical intervention. Previous studies have examined perioperative complications, with 30-day readmission and mortality rates of up to 10% and 2%, respectively. Most such studies have included patients with pathologic fractures and those that had been inpatients prior to their procedures. Such shortcomings make it difficult for surgeons in office settings to accurately counsel patients regarding their risks for electively scheduled augmentation. PURPOSE To determine the 30-day postoperative complication rates for inpatient versus outpatient elective vertebral augmentation procedure performed for osteoporotic VCFs. STUDY DESIGN/SETTING Retrospective analysis of prospectively collected database. PATIENT SAMPLE Patients that underwent kyphoplasty or vertebroplasty were identified using CPT codes. To identify elective cases, only patients designated with “elective” status and those with ASA score 3 or under were selected. Patients that were inpatient status prior to the procedure, patients that were transferred from outside facility, patients that required preoperative blood transfusion, and those who were dependent on ventilator were excluded. To select only the osteoporotic VCFs, patients with disseminated cancer and those that underwent chemotherapy or radiotherapy were excluded. OUTCOME MEASURES Outcomes investigated were mortality, sepsis, cardiovascular complications, re-intubation, pneumonia, renal complications, stroke, wound complications, UTI, DVT, PE and transfusion. Also assessed were unplanned reoperation, unplanned readmission and discharge destination. METHODS The NSQIP database 2011-2014 was queried. Rates of 30-day postoperative complications, reoperations and readmissions were compared between the inpatient and the outpatient groups using univariate analyses. Multivariable analysis was proposed, however, was not performed since univariate analyses did not reveal meaningful differences. RESULTS A total of 1,539 patients were identified. Of those, 555 patients underwent inpatient surgery while 984 patients underwent outpatient surgery. Mean ages for inpatient and outpatient groups were 76.0 and 73.7, respectively. The 30-day postoperative complication rates were low for both groups. The mortality rates for the inpatient and outpatient groups were 0.19% and 0.31%, respectively, with no significant difference. UTI and sepsis were the only complications significantly different between the two groups. UTI occurred in 2.28% in the inpatient group and 0.94% in the outpatient group. Sepsis occurred in 0.95% of patients that underwent inpatient surgery, while no patient that underwent outpatient procedure sustained sepsis. Readmission (7.98% vs 5.74%) and reoperation (3.23% vs 2.92%) were both higher in inpatient group, however, the differences were not significant. CONCLUSIONS The only statistically significant differences in short-term morbidity from elective vertebral augmentation performed for osteoporotic VCFs were sepsis and UTI, with higher rates in inpatient group. The analysis suggests that outpatient vertebral augmentation may be safely performed in appropriate patient cohort. Compared with published studies that included pathologic fractures and patients that had been previously admitted, our study reported substantially lower 30-day mortality and readmission rates for electively scheduled augmentation of osteoporotic VCFs. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.