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. 2018 Aug 31;12(4):453-459.
doi: 10.14444/5054. eCollection 2018 Aug.

Trends in the Use of Bone Morphogenetic Protein-2 in Adult Spinal Deformity Surgery: A 10-Year Analysis of 54 054 Patients

Rafael DE LA Garza Ramos  1   2 , Jonathan Nakhla  1   2 , Niketh Bhashyam  1   2 , Adam E Ammar  1   2 , Aleka N Scoco  1   2 , Merrit D Kinon  1   2 , Reza Yassari  1   2
Affiliations

Trends in the Use of Bone Morphogenetic Protein-2 in Adult Spinal Deformity Surgery: A 10-Year Analysis of 54 054 Patients

Rafael DE LA Garza Ramos et al. Int J Spine Surg. .

Abstract

Background: Bone morphogenetic protein-2 (BMP-2) is an available bone graft option in spinal fusion surgery. The purpose of this study is to investigate the trends of BMP-2 utilization in adult spinal deformity (ASD) surgery.

Methods: The Nationwide Inpatient Sample database from 2002 to 2011 was reviewed. Inclusion criteria were patients over 18 years of age who underwent spinal fusion for ASD. Trends of BMP-2 use were examined over time, as well as stratified based on patient and surgical characteristics. All analyses were done after application of discharge weights to produce national estimates.

Results: There were 54 054 patients who met inclusion criteria and were included in this study. The overall rate of BMP-2 use was 39.7% (95% confidence interval 35.0%- 44.3%). Overall, there was steady increase in its use over time, with the highest peak in 2009 (55.3% of all cases used BMP-2), and then a decrease up to 37.9% in 2011 (P < .001). The rate of BMP-2 use was significantly higher for patients older than 54 years of age (compared to patients <54, P < .001). It was also higher in females (P = .009), Caucasian patients (P = .006), and Medicare patients (P = .006). Its use was 28.6% in the Northeast, 38.1% in the South, 45.2% in the Midwest, and 48.2% in the West (P = .035). Circumferential procedures had the highest rate of BMP-2 use (44.3%, P = .045). Average total hospital charges were $152,403 ± 117,454 for patients who did not receive BMP-2 and $205,426 ± 137,561 for patients who did (P < .001).

Conclusion: After analysis of a large nationwide database, it was found that the rate of BMP-2 use in ASD surgery is approximately 40%. There was a significant increase in use from 2002 to 2009, and a decrease thereafter. The highest rates of use were found in older patients, female patients, white patients, Medicare patients, circumferential approaches, and patients undergoing surgery in the Midwest and West regions.

Keywords: Nationwide Inpatient Sample; adult spinal deformity; bmp-2; bone morphogenetic protein; trends.

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Conflict of interest statement

Disclosures and COI: The manuscript submitted does not contain information about medical device(s)/drug(s). No funds were received in support of this work. The authors have no conflicts of interest.

Figures

Figure 1
Figure 1
Rate of BMP-2 use over time (P < .001).
Figure 2
Figure 2
Rates of BMP-2 use stratified by (A) age group, (B) sex, (C) race, (D) insurance, (E) hospital region, and (F) hospital teaching status. All changes over time were found to be statistically significant (all P < .001).
Figure 3
Figure 3
Rates of BMP-2 use stratified by (A) primary versus revision status, (B) use of osteotomy, and (C) number of levels fused. All changes over time were found to be statistically significant (all P < .001).
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