title: 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.
abstract: OBJECTIVE
  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]).
  
  
  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.
authors.affiliation: Neuro-Spine Program, Division of Pediatric Neurosurgery, Texas Children's Hospital, and Department of Neurosurgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Sandi K
authors.initials: SK
authors.lastname: Lam
authors.forename: Christina
authors.initials: C
authors.lastname: Sayama
authors.forename: Dominic A
authors.initials: DA
authors.lastname: Harris
authors.forename: Valentina
authors.initials: V
authors.lastname: Briceño
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Luerssen
authors.forename: Andrew
authors.initials: A
authors.lastname: Jea
mesh_terms: D000293:Adolescent; D055396:Bone Morphogenetic Protein 2 / Q000627:therapeutic use*; D002574:Cervical Vertebrae; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008159:Lumbar Vertebrae; D008297:Male; D016017:Odds Ratio; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011994:Recombinant Proteins / Q000627:therapeutic use; D012086:Reoperation; D013121:Spinal Curvatures / Q000601:surgery; D016103:Spinal Fractures / Q000601:surgery; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data*; D013131:Spine / Q000601:surgery*; D013168:Spondylolisthesis / Q000601:surgery; D013904:Thoracic Vertebrae; D016212:Transforming Growth Factor beta / Q000627:therapeutic use*; D014481:United States; D055815:Young Adult
chemical_list: D055396:Bone Morphogenetic Protein 2; D011994:Recombinant Proteins; D016212:Transforming Growth Factor beta; C499469:recombinant human bone morphogenetic protein-2
keywords: DVT = deep venous thrombosis; ICD-9-CM = International Classification of Diseases, Ninth Revision, Clinical Modifications; KID = Kids' Inpatient Database; LOS = length of hospital stay; aOR = adjusted odds ratio; bone morphogenetic protein; pediatric spine; practice patterns; rhBMP-2 = recombinant human bone morphogenetic protein–2; spinal instrumentation