Have referral patterns for vertebroplasty changed since publication of the placebo-controlled trials?

BACKGROUND AND PURPOSE Our aim was to determine whether referral patterns and rates of vertebroplasties at the Mayo Clinic have changed after the publication of the INVEST and the Australian Trial. In August of 2009, we performed a retrospective review of patients undergoing vertebroplasties and those patients who were referred for but did not receive vertebroplasties before and after the recently published placebo-controlled vertebroplasty trials. MATERIALS AND METHODS After approval by our local institutional review board, we retrospectively evaluated all patients referred for vertebroplasty between January 5, 2004, and June 2, 2010. We catalogued age, sex, number of treated vertebrae, physician referring the patient for vertebroplasty, and the referring department. We calculated the mean number of referrals per month before and after August 2009, which was the month of publication for both trials. We also calculated rates for specific referring physician types. RESULTS During the full study, 1188 patients were referred, of whom 807 underwent treatment at 1378 levels for a total of 943 separate vertebroplasty procedures. The mean number of vertebroplasty referrals per month has dropped significantly from 18.9 ± 5.3 (95% CI, 17.7-20.2) before publication to 11.3 ± 3.1 (95% CI, 9.1-13.5) referrals per month after publication (P=.0001). Before publication, 67.3 ± 14.0% (95% CI, 64.0%-70.7%) of patients referred for vertebroplasty underwent vertebroplasty, compared with 76.0 ± 14.9% (95% CI, 65.4%-86.6%) after publication (P=.11). CONCLUSIONS The number of vertebroplasty referrals at our center has decreased significantly since the publication of INVEST and the Australian Trial, yet we continue to offer the procedure to a high proportion of referred patients.