Abstract No. 463 Percutaneous vertebral augmentation in the oldest old: comparative evaluation of comorbidities, outcomes and disparities

Abstract

The “oldest old” refers to the patient population at the apex of the age pyramid and is classically defined as patients over the age of 85. Recent studies have demonstrated a nonlinear association between patients’ age and surgical complications and outcomes, with the oldest old having noninferior outcomes when compared to youngest-old (age, 65–74 years) and middle-old (age, 75–84 years) patients. However, data regarding outcomes of percutaneous vertebral augmentation (PVA), including vertebroplasty and kyphoplasty, is limited in this age-group. Hospitalizations for the primary purpose of PVA in the setting of vertebral compression fractures were identified using the ICD 9th and 10th version diagnosis and procedure codes in the National Inpatient Sample between 2012 and 2017. Baseline characteristics, associated diagnoses, comorbidities, post-procedure complications (respiratory, cardiovascular, neurologic, infectious, and site-specific/device-related complications), and outcomes (mortality, length of stay, disposition, and hospital charges) were extracted. Multivariate regression modeling was used to calculate adjusted odds ratios (aOR) for the association between age and outcomes. Overall, the estimated number of PVA procedures in the youngest-old, middle-old, and oldest old populations was 29,975 ± 498, 51,475 ± 753, and 42,255 ± 682, respectively (P < 0.01 compared with youngest-old). The incidence of underlying malignancy in each age-group was 16.2% ± 0.6, 11.6% ± 0.4, and 6.8% ± 0.3 (P for trend < 0.01), respectively. In multivariable models adjusted for baseline characteristics and compared to the youngest-olds, the oldest old had similar mortality rates (aOR: 1.1 [0.7–1.8], P: 0.52) [sic], lower risk of post-procedural complications (aOR: 0.5 [0.4–0.7], P < 0.01), shorter hospitalization (aOR: 0.7 [0.6–0.8], P < 0.01) and lower hospital costs (aOR: 0.6 [0.5–0.7], P < 0.01) following PVA. Patients over the age of 85 have similar, if not better, outcomes after PVA with comparable mortality, lower rates of complications, shorter hospital stays, and lower hospital expenses when compared to “younger” older adult patients.