Nationwide practice patterns in the use of recombinant human bone morphogenetic protein-2 in pediatric spine surgery as a function of patient-, hospital-, and procedure-related factors

Sandi K. Lam, Christina Sayama, Dominic A. Harris, Valentina Briceño, Thomas G. Luerssen, Andrew Jea

Research output: Contribution to journalArticle

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Abstract

CONCLUSIONS: Use of BMP in pediatric spine procedures now comprises more than 10% of pediatric spinal fusion. Patient-related (age, insurance type, diagnosis); hospital-related (children's hospital vs general hospital, region in the US); and procedure-related (redo fusion, anterior vs posterior approach, spinal levels, number of levels fused) factors are associated with the variation in BMP use in the US.

OBJECT: Current national patterns as a function of patient-, hospital-, and procedure-related factors, and complication rates in the use of recombinant human bone morphogenetic protein-2 (rhBMP-2) as an adjunct to the practice of pediatric spine surgery have scarcely been investigated.

METHODS: The authors conducted a cross-sectional study using data from the Healthcare Cost and Utilization Project Kids' Inpatient Database. Univariate and multivariate logistic regression were used to calculate unadjusted and adjusted odds ratios and 95% confidence intervals, and p values <0.05 were considered to be statistically significant.

RESULTS: The authors identified 9538 hospitalizations in pediatric patients 20 years old or younger who had undergone spinal fusion in the US in 2009; 1541 of these admissions were associated with rhBMP-2 use. By multivariate logistic regression, the following factors were associated with rhBMP-2 use: patient age 15-20 years; length of hospital stay (adjusted odds ratio [aOR] 1.01, p = 0.017); insurance status (private [aOR 1.49, p <0.001] compared with Medicaid); hospital type (nonchildren's hospital); region (Midwest [aOR 2.49, p = 0.008] compared with Northeast); spinal refusion (aOR 2.20, p <0.001); spinal fusion approach/segment (anterior lumbar [aOR 1.73, p <0.001] and occipitocervical [aOR 1.86, p = 0.013] compared with posterior lumbar); short segment length (aOR 1.42, p = 0.016) and midlength (aOR 1.44, p = 0.005) compared with long; and preoperative diagnosis (Scheuermann kyphosis [aOR 1.56, p <0.017] and spondylolisthesis [aOR 1.93, p <0.001]).

Original languageEnglish (US)
Pages (from-to)476-485
Number of pages10
JournalJournal of neurosurgery. Pediatrics
Volume14
Issue number5
DOIs
StatePublished - Nov 1 2014
Externally publishedYes

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Spine
Odds Ratio
Pediatrics
Spinal Fusion
Length of Stay
recombinant human bone morphogenetic protein-2
Scheuermann Disease
Logistic Models
Spondylolisthesis
Insurance Coverage
Medicaid
Insurance
General Hospitals
Health Care Costs
Inpatients
Hospitalization
Cross-Sectional Studies
Databases
Confidence Intervals

Keywords

  • aOR = adjusted odds ratio
  • bone morphogenetic protein
  • DVT = deep venous thrombosis
  • ICD-9-CM = International Classification of Diseases, Ninth Revision, Clinical Modifications
  • KID = Kids' Inpatient Database
  • LOS = length of hospital stay
  • pediatric spine
  • practice patterns
  • rhBMP-2 = recombinant human bone morphogenetic protein–2
  • spinal instrumentation

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Nationwide practice patterns in the use of recombinant human bone morphogenetic protein-2 in pediatric spine surgery as a function of patient-, hospital-, and procedure-related factors. / Lam, Sandi K.; Sayama, Christina; Harris, Dominic A.; Briceño, Valentina; Luerssen, Thomas G.; Jea, Andrew.

In: Journal of neurosurgery. Pediatrics, Vol. 14, No. 5, 01.11.2014, p. 476-485.

Research output: Contribution to journalArticle

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abstract = "CONCLUSIONS: Use of BMP in pediatric spine procedures now comprises more than 10{\%} of pediatric spinal fusion. Patient-related (age, insurance type, diagnosis); hospital-related (children's hospital vs general hospital, region in the US); and procedure-related (redo fusion, anterior vs posterior approach, spinal levels, number of levels fused) factors are associated with the variation in BMP use in the US.OBJECT: Current national patterns as a function of patient-, hospital-, and procedure-related factors, and complication rates in the use of recombinant human bone morphogenetic protein-2 (rhBMP-2) as an adjunct to the practice of pediatric spine surgery have scarcely been investigated.METHODS: The authors conducted a cross-sectional study using data from the Healthcare Cost and Utilization Project Kids' Inpatient Database. Univariate and multivariate logistic regression were used to calculate unadjusted and adjusted odds ratios and 95{\%} confidence intervals, and p values <0.05 were considered to be statistically significant.RESULTS: The authors identified 9538 hospitalizations in pediatric patients 20 years old or younger who had undergone spinal fusion in the US in 2009; 1541 of these admissions were associated with rhBMP-2 use. By multivariate logistic regression, the following factors were associated with rhBMP-2 use: patient age 15-20 years; length of hospital stay (adjusted odds ratio [aOR] 1.01, p = 0.017); insurance status (private [aOR 1.49, p <0.001] compared with Medicaid); hospital type (nonchildren's hospital); region (Midwest [aOR 2.49, p = 0.008] compared with Northeast); spinal refusion (aOR 2.20, p <0.001); spinal fusion approach/segment (anterior lumbar [aOR 1.73, p <0.001] and occipitocervical [aOR 1.86, p = 0.013] compared with posterior lumbar); short segment length (aOR 1.42, p = 0.016) and midlength (aOR 1.44, p = 0.005) compared with long; and preoperative diagnosis (Scheuermann kyphosis [aOR 1.56, p <0.017] and spondylolisthesis [aOR 1.93, p <0.001]).",
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AU - Briceño, Valentina

AU - Luerssen, Thomas G.

AU - Jea, Andrew

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KW - LOS = length of hospital stay

KW - pediatric spine

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