Demographic and economic trends in vertebral fracture surgeries throughout the United States

Incidence of Traumatic Spinal Injury Following Public Policy Update on Moped Usage in South Carolina

BACKGROUND

Electric scooters and mopeds have become prevalent modes of transportation for many Americans. On 19 November 2018, South Carolina implemented a law mandating the registration of these vehicles with the South Carolina Department of Motor Vehicles, enabling better regulation of moped and scooter drivers on the roads. This study aims to investigate whether the incidence of vertebral fractures and spinal cord injuries related to moped and scooter accidents decreased after the passage of this 2018 South Carolina law.

METHODS

Retrospective data from a cohort of 350 patients, 239 before ("prelaw") and 111 after the law ("postlaw") was implemented, seeking care at a level 1 trauma center for moped or scooter-related spinal injuries between January 2014 and December 2022 were analyzed. Differences in the incidence of vertebral fractures and spinal cord injuries before and after the passage of the South Carolina law were calculated. Vertebral fractures were categorized by location on the spine pre- and postlaw. χ 2, Wilcoxon rank sum, and Shapiro-Wilk tests were employed to compare variables between groups.

RESULTS

A total of 60 traumatic vertebral fractures (47 prelaw and 13 postlaw) and 7 spinal cord injuries involved moped accidents. There was no significant difference in the incidence rate of vertebral fractures (19.7% vs 11.7%, P = 0.09) or spinal cord injuries (2.9% vs 0%, P = 0.1) between those injured prelaw and postlaw, although there were significant differences between the groups in age (43.2 vs 47.4, P < 0.01) and incidence of men injured (87.9% vs 95.5%, P = 0.03). Multivariable logistic regression demonstrated suffering a moped-related traumatic injury before the implementation of the 2018 South Carolina law (OR = 2.08, 95% CI: 1.09-4.23, P = 0.03) and an increase in age at the time of injury (OR = 1.03, 95% CI: 1.01-1.05, P = 0.01) were independently associated with an increase in the odds ratio of suffering traumatic vertebral fractures following a moped accident when controlling for multiple confounding factors.

CONCLUSION

Before the implementation of a 2018 South Carolina law that increased moped regulations, moped drivers had a significantly higher odds ratio for suffering a traumatic vertebral fracture compared with after the implementation of the law when controlling for confounding factors. These findings suggest that public policy surrounding moped use may contribute to a decrease in the overall odds of suffering vertebral fractures resulting from moped use and emphasize the need for continual updates to public policy with public safety in mind. This is not only important from a standpoint of patient safety, but it also helps to decrease the amount of health care resources and dollars used.

CLINICAL RELEVANCE

Implementation of public policy surrounding use of mopeds may decrease overall odds of vertebral fractures, which may decrease subsequent health care resource utilization.

LEVEL OF EVIDENCE: 3

Physical Therapy for Patients with Thoracolumbar Vertebral Fractures

Vertebral fractures are a common cause of back pain and pain-related functional impairments in elderly patients. Despite their widespread occurrence, vertebral fractures frequently remain underdiagnosed, often leading to suboptimal management and poor clinical outcomes. This review specifically examines the role of physical therapy (PT) in managing vertebral fractures, describing current literature and evidence-based guidelines from the American Physical Therapy Association and the American Academy of Orthopaedic Surgeons. PT following vertebral fractures has been shown to significantly improve back pain and patient-reported outcomes, with studies even showing a correlation between resistance and aerobic training with improved bone mineral density. These findings highlight the need for interdisciplinary care and comprehensive PT interventions to address the growing burden of vertebral fractures as their incidence rises with the aging population.

Challenges in Orthopedic Surgical Decision-Making for Multilevel Vertebrae Fractures

Vertebral fractures commonly occur in postmenopausal women due to decreased bone density, a condition known as osteoporosis. They can occur after minimal trauma or even during routine activities. Vertebral fractures occur predominantly in individuals with a high fall risk. This case report explores the clinical complexities surrounding a 65-year-old female patient with a history of multilevel vertebrae fractures compounded by a history of chronic smoking, osteoporosis, multiple falls, and evident signs of osteopenia on X-ray. These risk factors complicate the decision to perform surgery and highlight the importance of constantly weighing the benefits and possible risks. This paper aims to emphasize the gender-specific challenges healthcare providers encounter when assessing surgical risks in the context of postmenopausal females with significant comorbidities. It underlines the need for tailored and comprehensive care strategies to manage orthopedic conditions in high-risk female individuals, further aligning with one of the World Health Organization's concerns on addressing gender-specific health considerations.

In-hospital mortality trends after surgery for traumatic thoracolumbar injury: A national inpatient sample database study

Introduction

Given the increasing incidence of traumatic thoracolumbar injuries in recent years, studies have sought to investigate potential risk factors for outcomes in these patients.

Research question

The aim of this study was to investigate trends and risk factors for in-hospital mortality after fusion for traumatic thoracolumbar injury.

Materials and methods

Patients undergoing thoracolumbar fusion after traumatic injury were queried from the National Inpatient Sample (NIS) from 2012 to 2017. Analysis was performed to identify risk factors for inpatient mortality after surgery.

Results

Patients in 2017 were on average older (51.0 vs. 48.5, P = 0.004), had more admitting diagnoses (15.5 vs. 10.7, p < 0.001), were less likely to be White (75.8% vs. 81.2%, p = 0.006), were from a ZIP code with a higher median income quartile (Quartile 1: 31.4% vs. 28.6%, p = 0.011), and were more likely to have Medicare as a primary payer (22.9% vs. 30.1%, p < 0.001). Bivariate analysis of demographics and surgical characteristics demonstrated that patients in the in-hospital mortality group (n = 90) were older (70.2 vs. 49.6, p < 0.001), more likely to be male (74.4% vs. 62.8%, p = 0.031), had a great number of admitted diagnoses (21.3 vs. 12.7, p < 0.001), and were more likely to be insured by Medicare (70.0% vs. 27.0%, p < 0.001). Multivariate regression analysis found age (OR 1.06, p < 0.001) and Black race (OR 3.71, p = 0.007) were independently associated with in-hospital mortality.

Conclusion

Our study of nationwide, traumatic thoracolumbar fusion procedures from 2012 to 2017 in the NIS database found older, black patients were at increased risk for in-hospital mortality after surgery.

A National Database Retrospective Review of Short-Term Postoperative Mortality in the Geriatric Population: A Comparison Between Emergency Spine Fractures and Hip Fractures

BACKGROUND

Mortality rates following emergency spine fracture surgery are high, especially in the elderly. However, how the postoperative mortality rate following spine fractures compares to other geriatric fractures such as hip fractures remains unclear. Therefore, this retrospective cohort study aimed to compare 30-day mortality rates and risk factors between emergency spine fracture versus hip fracture surgery in the elderly.

METHODS

The National Surgical Quality Improvement Program (NSQIP) database was queried between 2011 and 2021 for emergency spine fractures and hip fractures in the elderly. Univariate analyses evaluated demographic data, perioperative factors, comorbidities, and 30-day mortality rates as the primary outcomes. A multivariable regression model was then constructed to control for significant baseline and demographic differences and evaluate independent predictors of mortality.

RESULTS

A total of 18,287 emergency hip fractures and 192 emergency spine fractures were included in our study. Univariate analysis demonstrated significant differences in female sex, body mass index (BMI), operation time, length of hospital stays, disseminated cancer, and functional dependence between spine and hip fractures. Thirty-day mortality rates were significantly higher in spine versus hip fractures (9.4% vs. 5%). Multivariate regression analysis demonstrated emergent spine fracture surgery, disseminated cancer, functional dependence, and length of stay as independent predictors of mortality in our cohort. Female sex, BMI, and operation time were protective factors for mortality in our cohort.

CONCLUSIONS

Emergency spine fractures in the elderly represent an independent predictor for 30-day postoperative mortality compared to emergency hip fractures. Disseminated cancer, functional dependence, and length of stay were independent predictors of mortality while female sex, BMI, and operation time were protective factors. These data demonstrate the severity of injury and high rates of mortality that clinicians can use to counsel patients and their families.