Prevalence, Complications, and Hospital Charges Associated With Use of Bone-Morphogenetic Proteins in Spinal Fusion Procedures

TLDR

National data on bone‑morphogenetic protein use in spinal fusion are lacking, yet BMP utilization has risen sharply from 0.69 % of all fusions in 2002 to 24.9 % in 2006. This study aimed to quantify BMP usage patterns, associated complication rates, and hospital charges in spinal fusion procedures across the United States. Using a retrospective cohort of 328,468 fusion patients from the 2002‑2006 Nationwide Inpatient Sample, the authors examined BMP use, complications, length of stay, and costs. BMP was used in roughly 25 % of fusions in 2006, was more common among women and Medicare patients, less common in non‑white patients, was linked to higher complication rates in anterior cervical fusions, and increased inpatient charges by 11‑41 % across all fusion types.

Abstract

No national data exist to examine use of bone-morphogenetic proteins (BMPs) in spinal fusion surgery.To determine the patterns of use and rates of complications and financial charges associated with BMP use in spinal fusion nationally.Retrospective cohort study of 328,468 patients undergoing spinal fusion procedures from 2002-2006 identified from the Nationwide Inpatient Sample database, a 20% sample of US community hospitals.The rates of use of BMP among patients undergoing spinal fusion procedures are examined along with complications, length of stay, and hospital charges associated with use of this fusion adjunct.The nationwide usage of BMP has increased from 0.69% of all fusions in 2002 to 24.89% of all fusions in 2006. Use of BMP varied by patient sex, race, and primary payer with increased use seen in women (56.26% with BMP vs 53.35% without BMP; odds ratio [OR], 1.12; 95% confidence interval, [CI], 1.09-1.16) and Medicare patients (29.62% with BMP vs 27.16% without BMP; OR, 1.43; 95% CI, 1.31-1.56) and decreased use in nonwhite patients (8.69% with BMP vs 10.23% without BMP; OR, 0.80; 95% CI, 0.75-0.85). When comparing immediate postoperative, in-hospital rates of complications for the year 2006 among patients undergoing spinal fusion by BMP use status, no differences were seen for lumbar, thoracic, or posterior cervical procedures. On univariate analysis and after multivariable adjustment, the use of BMP in anterior cervical fusion procedures was associated with a higher rate of complication occurrence (7.09% with BMP vs 4.68% without BMP; adjusted OR, 1.43; 95% CI, 1.12-1.70) with the primary increases seen in wound-related complications (1.22% with BMP vs 0.65% without BMP; adjusted OR, 1.67; 95% CI, 1.10- 2.53) and dysphagia or hoarseness (4.35% with BMP vs 2.45% without BMP; adjusted OR, 1.63; 95% CI, 1.30-2.05). Bone-morphogenetic protein use was associated with greater inpatient hospital charges across all categories of fusion. Increases between 11% and 41% of total hospital charges were reported, with the greatest percentage increase seen for anterior cervical fusion.Bone-morphogenetic protein was used in approximately 25% of all spinal fusions nationally in 2006, with use associated with more frequent complications for anterior cervical fusions and with greater hospital charges for all categories of fusions.