Abstract
Background context
Bone morphogenetic proteins (BMPs) were developed with the goal of improving clinical
outcomes through the promotion of bony healing and reducing morbidity from iliac crest
bone graft harvest.
Purpose
To complete a population-based assessment of the impact of BMP on use of autograft,
rates of operative treatment for lumbar pseudoarthrosis, and hospital charges.
Study design
Nationwide Inpatient Sample (NIS) retrospective cohort assessment of 46,452 patients
from 2002 to 2008.
Patient sample
All patients who underwent lumbar arthrodesis procedures for degenerative spinal disease.
Outcome measures
Use of BMP, revision surgery status as a percentage of total procedures, and autograft
harvest in lumbar fusion procedures completed for degenerative diagnoses.
Methods
Demographic and geographic/practice data, hospital charges, and length of stay of
all NIS patients with thoracolumbar and lumbosacral procedure codes for degenerative
spinal diagnoses were recorded. Codes for autograft harvest, use of BMP, and revision
surgery were included in multivariable regression analysis.
Results
The assessment found 46,452 patients from 2002 to 2008 undergoing thoracolumbar or
lumbar arthrodesis procedures for degenerative disease. Assuming a representative
sample, this cohort models more than 200,000 US patients. There was steady growth
in lumbar spine fusion and in the use of BMP. The use of BMP increased from 2002 to
2008 (odds ratio [OR], 1.50; 95% confidence interval [CI], 1.48–1.52). Revision procedures
decreased over the study period (OR, 0.94; 95% CI, 0.91–0.96). The use of autograft
decreased substantially after introduction of BMP but then returned to baseline levels;
there was no net change in autograft use from 2002 to 2008. The use of BMP correlated
with significant increases in hospital charges ($13,362.39; standard deviation±596.28,
p<.00001). The use of BMP in degenerative thoracolumbar procedures potentially added
more than $900 million to hospital charges from 2002 to 2008.
Conclusions
There was an overall decrease in rates of revision fusion procedures from 2002 to
2008. Introduction of BMP did not correlate with decrease in use of autograft bone
harvest. Use of BMP correlated with substantial increase in hospital charges. The
small decrease in revision surgeries recorded, combined with lack of significant change
in autograft harvest rates, may question the financial justification for the use of
BMP.
Keywords
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Article info
Publication history
Published online: December 07, 2012
Accepted:
October 26,
2012
Received in revised form:
February 15,
2012
Received:
June 15,
2011
Footnotes
FDA device/drug status: Approved (bone morphogenetic protein—Infuse).
Author disclosures: PRD: Nothing to disclose. RGW: Nothing to disclose. GAS: Nothing to disclose. MGM: Nothing to disclose. JKR: Royalties: Biomet Spine (E); Stock Ownership: Johnson and Johnson (0 shares, sold); Consulting: Stryker Spine (D).
The disclosure key can be found on the Table of Contents and at www.TheSpineJournalOnline.com.
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
