Hospitalised patients with vertebral fragility fractures (VFF) represent a significant number, cost and use of bed days in England, however those who had early vertebral augmentation had a significantly shorter length of hospital stay. This is according to a recent study which was presented at the British Association of Spine Surgeons (BASS) 2022 meeting (23–25 March 2022; Belfast, UK) by professor Opinder Sahota (Nottingham University Hospitals NHS Trust, Nottingham, UK).
The study researchers, led by Chia Wei Tan (Nottingham University Hospitals NHS Trust, Nottingham, UK), conducted a retrospective analysis of analysis of patients aged 55 years and over admitted to hospitals across England from 2017-2019. ICD-10 classifications for VFF and OPCS codes were used to identify admissions and patients who had undergone vertebral augmentation (VA).
“VFFs are the most common osteoporotic fracture. VFF can result in significant pain requiring hospitalisation. However, there is little data on patient numbers, hospital bed days and costs, contributed to by these patients”, note the research team, adding that “further studies are necessary to define those who may benefit from early VA”.
A total of 99,240 patients (61% female) were admitted during this period, with 64,370 (65%) patients aged over 75. There was a 14.3% average increase in admissions annually. Patients aged over 75 years accounted for 1.5 million bed days, costing £465million (median length of stay [MLOS] 14.4 days). In comparison, those aged 55-74 years, accounted for 659,000 bed days, costing £239 million (MLOS 10.7 days).
The study found that the majority of patients (84%) were admitted under a non-surgical speciality and were primarily older (median age 76.8 vs. 67.6 years, MLOS 8.2 vs. 6 days).
Out of these 99,240 patients, 1,755 (1.8%) underwent VA. A total of 775 of these (44.2%) were aged 75 years and over. The MLOS and cost per patient admission was shown to be lower in the VA group compared to those managed non-surgically (MLOS 2.4 vs. 10.8 days, p=<0.01, cost £4,737 vs. £7,250).
Speaking to Spinal News International, Tan said: “Early recognition of VFF and identification of patients suitable for vertebral augmentation remains the key challenge. The findings highlight the increasing burden of VFF in our aging population and based on previous research, these numbers are likely to be an underestimate.
“Vertebral augmentation has significantly reduced length of stay, however total patient numbers having the procedure remain small. Further research focusing on the above would be a key catalyst for change nationally in the management of older patients admitted with VFF with the ultimate goal of improving patient outcomes.”