Use of Recombinant Bone Morphogenetic Protein is Associated with Reduced Risk of Reoperation after Spine Fusion for Adult Spinal Deformity.
Paul, Justin C.; Lonner, Baron S.; Vira, Shaleen; More
Spine., Post Author Corrections: September 1, 2015
Study Design. retrospective review.
Objective. This study follows the inpatient stay administrative data collected for a cohort of thousands of patients who had spine fusion surgery in the state of New York. We sought to examine adult spinal deformity (ASD) for reoperation events with and without the use of BMP.
Summary of Background Data. Randomized controlled trials have suggested that bone morphogenetic protein (BMP) may increase the likelihood of solid arthrodesis in spinal surgery. This would imply fewer reoperations for pseudarthrosis, but small cohort sizes are inadequate to monitor these events.
Methods. The 2008-2011 New York State Inpatient Database was queried using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Patients age 21 and older with a diagnosis of scoliosis and an index fusion of greater than 2 spinal motion segments were included. Patient identifiers and linkage variables were used to identify revisits. The relative risk of reoperation was calculated. The use of BMP at the initial inpatient stay was used to define the two cohorts for relative risk assessment.
Results. A total of 3,751 cases of ASD were identified in 2008. The use of BMP at the initial visit was performed at a rate of 37.6% for ASD. For posterior fusion cases longer than 8 levels, the rate of reoperation for a pseudarthrosis was 23.4%. For ASD fusions greater than 8 levels, the rate of reoperation for pseudarthrosis after using BMP at the index surgery was 5% and 33.9% when BMP was not used, a relative risk of 7.5 (p < 0.001).
Conclusion. Using relevant in-hospital patient records from the New York State Inpatient Sample, we found a 7.5-fold decrease in the risk of reoperation for pseudarthrosis after long fusions when using BMP. Decreased reoperation rates are likely due to the improved fusion with use of BMP. If subsequent unnecessary hospitals stays can be avoided, the economics of BMP use should be re-examined.
Level of Evidence: 4
Paul, Justin C.; Lonner, Baron S.; Vira, Shaleen; More
Spine., Post Author Corrections: September 1, 2015
Study Design. retrospective review.
Objective. This study follows the inpatient stay administrative data collected for a cohort of thousands of patients who had spine fusion surgery in the state of New York. We sought to examine adult spinal deformity (ASD) for reoperation events with and without the use of BMP.
Summary of Background Data. Randomized controlled trials have suggested that bone morphogenetic protein (BMP) may increase the likelihood of solid arthrodesis in spinal surgery. This would imply fewer reoperations for pseudarthrosis, but small cohort sizes are inadequate to monitor these events.
Methods. The 2008-2011 New York State Inpatient Database was queried using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Patients age 21 and older with a diagnosis of scoliosis and an index fusion of greater than 2 spinal motion segments were included. Patient identifiers and linkage variables were used to identify revisits. The relative risk of reoperation was calculated. The use of BMP at the initial inpatient stay was used to define the two cohorts for relative risk assessment.
Results. A total of 3,751 cases of ASD were identified in 2008. The use of BMP at the initial visit was performed at a rate of 37.6% for ASD. For posterior fusion cases longer than 8 levels, the rate of reoperation for a pseudarthrosis was 23.4%. For ASD fusions greater than 8 levels, the rate of reoperation for pseudarthrosis after using BMP at the index surgery was 5% and 33.9% when BMP was not used, a relative risk of 7.5 (p < 0.001).
Conclusion. Using relevant in-hospital patient records from the New York State Inpatient Sample, we found a 7.5-fold decrease in the risk of reoperation for pseudarthrosis after long fusions when using BMP. Decreased reoperation rates are likely due to the improved fusion with use of BMP. If subsequent unnecessary hospitals stays can be avoided, the economics of BMP use should be re-examined.
Level of Evidence: 4
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