339 - Complications of Bone Morphogenetic Protein Utilization in Anterior an...

#339 Complications of Bone Morphogenetic Protein Utilization in Anterior and Posterior Lumbar Fusions

Epidemiology/Natural History

Poster Presented by: K. Singh


A.J. Marquez-Lara (1)
S.V. Nandyala (1)
S.J. Fineberg (1)
M. Noureldin (1)
K. Singh (1)

(1) Rush University Medical Center, Orthopaedic Surgery, Chicago, IL, United States


Introduction: The utilization of bone morphogenetic protein (BMP) in spinal fusions has increased since its FDA approval in 2002. Recently, an independent review by the Yale Open Data Access (YODA) project demonstrated that the evidence regarding the utilization of BMP in spine surgery may be biased and more than likely underreported complications. In order to address some of the issues cited by the YODA project, a population-based database was analyzed for patient demographics, clinical outcomes, and hospital resource utilization associated with adjuvant BMP in lumbar fusion procedures.

Methods: Data from the Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project was queried from 2002-2011. Patients undergoing a 1-2 level anterior lumbar fusion (ALF) or posterior lumbar fusion (PLF) to treat lumbar degenerative conditions were identified and separated with regards to BMP utilization. Patient demographics, comorbidities (CCI), length of stay (LOS), costs, and the early postoperative outcomes were assessed. A student T-test and χ2-test were utilized to assess for statistically significant differences (p< 0.001).

Results: A total of 24,225 (11.4%) ALFs and 188,386 (88.6%) PLFs were identified between 2002-2011. BMP was utilized in 51.7% and 35.6% of the ALF and PLF procedures, respectively (p< 0.001). The patients who received BMP were significantly younger and demonstrated a lower comorbidity burden (p< 0.001). The utilization of BMP was associated with greater total hospital costs in both the ALF ($25,643 vs $23,476, p< 0.001) and PLF cohorts ($28,451 vs $23,065, p< 0.001). The utilization of BMP was also associated with a reduced incidence of postoperative infections (9.0 vs 16.3 per 1,000 cases, p< 0.001) and mortality (0.6 vs 1.0 per 1,000 cases, p< 0.001) after an ALF and PLF procedure, respectively.

Conclusion: BMP was more frequently utilized with an anterior approach. Despite a lower incidence of postoperative complications, patients who received BMP incurred a significantly greater total hospital cost. The BMP cohorts comprised of younger and healthier patients which may explain the lower incidence of postoperative infections in the ALF cohort and the reduced mortality rate among the PLF treated patients. Additional unbiased studies, including epidemiological trend analysis, should be pursued to further characterize the clinical impact of BMP in lumbar fusion surgery.

Table 1