Use of bone morphogenetic proteins in spinal fusion surgery for older adults with lumbar stenosis: Trends, complications, repeat surgery, and charges

Richard (Rick) Deyo, Alex Ching, Laura Matsen, Brook I. Martin, William Kreuter, Jeffrey G. Jarvik, Heather Angier, Sohail K. Mirza

Research output: Contribution to journalArticle

61 Citations (Scopus)

Abstract

Study Design.: Retrospective cohort study of Medicare claims. Objective.: Examine trends and patterns in the use of bone morphogenetic proteins (BMP) in surgery for lumbar stenosis; compare complications, reoperation rates, and charges for patients undergoing lumbar fusion with and without BMP. Summary of Background Data.: Small, randomized trials have demonstrated higher rates of solid fusion with BMP than with allograft bone alone, with few complications and, in some studies, reduced rates of revision surgery. However, complication and reoperation rates from large population-based cohorts in routine care are unavailable. Methods.: We identified patients with a primary diagnosis of lumbar stenosis who had fusion surgery in 2003 or 2004 (n = 16,822). We identified factors associated with BMP use: major medical complications during the index hospitalization, rates of rehospitalization within 30 days, and rates of reoperation within 4 years of follow-up (through 2008). Results.: Use of BMP increased rapidly, from 5.5% of fusion cases in 2003 to 28.1% of fusion cases in 2008. BMP use was greater among patients with previous surgery and among those having complex fusion procedures (combined anterior and posterior approach, or greater than 2 disc levels). Major medical complications, wound complications, and 30-day rehospitalization rates were nearly identical with or without BMP. Reoperation rates were also very similar, even after stratifying by previous surgery or surgical complexity, and after adjusting for demographic and clinical features. On average, adjusted hospital charges for operations involving BMP were about $15,000 more than hospital charges for fusions without BMP, though reimbursement under Medicare's Diagnosis-Related Group system averaged only about $850 more. Significantly fewer patients receiving BMP were discharged to a skilled nursing facility (15.9% vs. 19.0%, P <0.001). Conclusion.: In this older population having fusion surgery for lumbar stenosis, uptake of BMP was rapid, and greatest among patients with prior surgery or having complex fusion procedures. BMP appeared safe in the perioperative period, with no increase in major medical complications. Use of BMP was associated with greater hospital charges but fewer nursing home discharges, and was not associated with reduced likelihood of reoperation.

Original languageEnglish (US)
Pages (from-to)222-230
Number of pages9
JournalSpine
Volume37
Issue number3
DOIs
StatePublished - Feb 1 2012

Fingerprint

Spinal Fusion
Bone Morphogenetic Proteins
Reoperation
Pathologic Constriction
Hospital Charges
Medicare
Skilled Nursing Facilities
Perioperative Period
Diagnosis-Related Groups
Nursing Homes
Population
Allografts
Hospitalization

Keywords

  • bone morphogenetic protein
  • lumbar fusion
  • reoperations
  • spinal stenosis

ASJC Scopus subject areas

  • Clinical Neurology
  • Orthopedics and Sports Medicine

Cite this

Use of bone morphogenetic proteins in spinal fusion surgery for older adults with lumbar stenosis : Trends, complications, repeat surgery, and charges. / Deyo, Richard (Rick); Ching, Alex; Matsen, Laura; Martin, Brook I.; Kreuter, William; Jarvik, Jeffrey G.; Angier, Heather; Mirza, Sohail K.

In: Spine, Vol. 37, No. 3, 01.02.2012, p. 222-230.

Research output: Contribution to journalArticle

Deyo, Richard (Rick) ; Ching, Alex ; Matsen, Laura ; Martin, Brook I. ; Kreuter, William ; Jarvik, Jeffrey G. ; Angier, Heather ; Mirza, Sohail K. / Use of bone morphogenetic proteins in spinal fusion surgery for older adults with lumbar stenosis : Trends, complications, repeat surgery, and charges. In: Spine. 2012 ; Vol. 37, No. 3. pp. 222-230.
@article{9e428a5a2d97440883ff262b307a1cfc,
title = "Use of bone morphogenetic proteins in spinal fusion surgery for older adults with lumbar stenosis: Trends, complications, repeat surgery, and charges",
abstract = "Study Design.: Retrospective cohort study of Medicare claims. Objective.: Examine trends and patterns in the use of bone morphogenetic proteins (BMP) in surgery for lumbar stenosis; compare complications, reoperation rates, and charges for patients undergoing lumbar fusion with and without BMP. Summary of Background Data.: Small, randomized trials have demonstrated higher rates of solid fusion with BMP than with allograft bone alone, with few complications and, in some studies, reduced rates of revision surgery. However, complication and reoperation rates from large population-based cohorts in routine care are unavailable. Methods.: We identified patients with a primary diagnosis of lumbar stenosis who had fusion surgery in 2003 or 2004 (n = 16,822). We identified factors associated with BMP use: major medical complications during the index hospitalization, rates of rehospitalization within 30 days, and rates of reoperation within 4 years of follow-up (through 2008). Results.: Use of BMP increased rapidly, from 5.5{\%} of fusion cases in 2003 to 28.1{\%} of fusion cases in 2008. BMP use was greater among patients with previous surgery and among those having complex fusion procedures (combined anterior and posterior approach, or greater than 2 disc levels). Major medical complications, wound complications, and 30-day rehospitalization rates were nearly identical with or without BMP. Reoperation rates were also very similar, even after stratifying by previous surgery or surgical complexity, and after adjusting for demographic and clinical features. On average, adjusted hospital charges for operations involving BMP were about $15,000 more than hospital charges for fusions without BMP, though reimbursement under Medicare's Diagnosis-Related Group system averaged only about $850 more. Significantly fewer patients receiving BMP were discharged to a skilled nursing facility (15.9{\%} vs. 19.0{\%}, P <0.001). Conclusion.: In this older population having fusion surgery for lumbar stenosis, uptake of BMP was rapid, and greatest among patients with prior surgery or having complex fusion procedures. BMP appeared safe in the perioperative period, with no increase in major medical complications. Use of BMP was associated with greater hospital charges but fewer nursing home discharges, and was not associated with reduced likelihood of reoperation.",
keywords = "bone morphogenetic protein, lumbar fusion, reoperations, spinal stenosis",
author = "Deyo, {Richard (Rick)} and Alex Ching and Laura Matsen and Martin, {Brook I.} and William Kreuter and Jarvik, {Jeffrey G.} and Heather Angier and Mirza, {Sohail K.}",
year = "2012",
month = "2",
day = "1",
doi = "10.1097/BRS.0b013e31821bfa3a",
language = "English (US)",
volume = "37",
pages = "222--230",
journal = "Spine",
issn = "0362-2436",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

TY - JOUR

T1 - Use of bone morphogenetic proteins in spinal fusion surgery for older adults with lumbar stenosis

T2 - Trends, complications, repeat surgery, and charges

AU - Deyo, Richard (Rick)

AU - Ching, Alex

AU - Matsen, Laura

AU - Martin, Brook I.

AU - Kreuter, William

AU - Jarvik, Jeffrey G.

AU - Angier, Heather

AU - Mirza, Sohail K.

PY - 2012/2/1

Y1 - 2012/2/1

N2 - Study Design.: Retrospective cohort study of Medicare claims. Objective.: Examine trends and patterns in the use of bone morphogenetic proteins (BMP) in surgery for lumbar stenosis; compare complications, reoperation rates, and charges for patients undergoing lumbar fusion with and without BMP. Summary of Background Data.: Small, randomized trials have demonstrated higher rates of solid fusion with BMP than with allograft bone alone, with few complications and, in some studies, reduced rates of revision surgery. However, complication and reoperation rates from large population-based cohorts in routine care are unavailable. Methods.: We identified patients with a primary diagnosis of lumbar stenosis who had fusion surgery in 2003 or 2004 (n = 16,822). We identified factors associated with BMP use: major medical complications during the index hospitalization, rates of rehospitalization within 30 days, and rates of reoperation within 4 years of follow-up (through 2008). Results.: Use of BMP increased rapidly, from 5.5% of fusion cases in 2003 to 28.1% of fusion cases in 2008. BMP use was greater among patients with previous surgery and among those having complex fusion procedures (combined anterior and posterior approach, or greater than 2 disc levels). Major medical complications, wound complications, and 30-day rehospitalization rates were nearly identical with or without BMP. Reoperation rates were also very similar, even after stratifying by previous surgery or surgical complexity, and after adjusting for demographic and clinical features. On average, adjusted hospital charges for operations involving BMP were about $15,000 more than hospital charges for fusions without BMP, though reimbursement under Medicare's Diagnosis-Related Group system averaged only about $850 more. Significantly fewer patients receiving BMP were discharged to a skilled nursing facility (15.9% vs. 19.0%, P <0.001). Conclusion.: In this older population having fusion surgery for lumbar stenosis, uptake of BMP was rapid, and greatest among patients with prior surgery or having complex fusion procedures. BMP appeared safe in the perioperative period, with no increase in major medical complications. Use of BMP was associated with greater hospital charges but fewer nursing home discharges, and was not associated with reduced likelihood of reoperation.

AB - Study Design.: Retrospective cohort study of Medicare claims. Objective.: Examine trends and patterns in the use of bone morphogenetic proteins (BMP) in surgery for lumbar stenosis; compare complications, reoperation rates, and charges for patients undergoing lumbar fusion with and without BMP. Summary of Background Data.: Small, randomized trials have demonstrated higher rates of solid fusion with BMP than with allograft bone alone, with few complications and, in some studies, reduced rates of revision surgery. However, complication and reoperation rates from large population-based cohorts in routine care are unavailable. Methods.: We identified patients with a primary diagnosis of lumbar stenosis who had fusion surgery in 2003 or 2004 (n = 16,822). We identified factors associated with BMP use: major medical complications during the index hospitalization, rates of rehospitalization within 30 days, and rates of reoperation within 4 years of follow-up (through 2008). Results.: Use of BMP increased rapidly, from 5.5% of fusion cases in 2003 to 28.1% of fusion cases in 2008. BMP use was greater among patients with previous surgery and among those having complex fusion procedures (combined anterior and posterior approach, or greater than 2 disc levels). Major medical complications, wound complications, and 30-day rehospitalization rates were nearly identical with or without BMP. Reoperation rates were also very similar, even after stratifying by previous surgery or surgical complexity, and after adjusting for demographic and clinical features. On average, adjusted hospital charges for operations involving BMP were about $15,000 more than hospital charges for fusions without BMP, though reimbursement under Medicare's Diagnosis-Related Group system averaged only about $850 more. Significantly fewer patients receiving BMP were discharged to a skilled nursing facility (15.9% vs. 19.0%, P <0.001). Conclusion.: In this older population having fusion surgery for lumbar stenosis, uptake of BMP was rapid, and greatest among patients with prior surgery or having complex fusion procedures. BMP appeared safe in the perioperative period, with no increase in major medical complications. Use of BMP was associated with greater hospital charges but fewer nursing home discharges, and was not associated with reduced likelihood of reoperation.

KW - bone morphogenetic protein

KW - lumbar fusion

KW - reoperations

KW - spinal stenosis

UR - http://www.scopus.com/inward/record.url?scp=84856698574&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84856698574&partnerID=8YFLogxK

U2 - 10.1097/BRS.0b013e31821bfa3a

DO - 10.1097/BRS.0b013e31821bfa3a

M3 - Article

C2 - 21494195

AN - SCOPUS:84856698574

VL - 37

SP - 222

EP - 230

JO - Spine

JF - Spine

SN - 0362-2436

IS - 3

ER -