title: Usage of recombinant human bone morphogenetic protein in cervical spine procedures: analysis of the MarketScan longitudinal database.
abstract: BACKGROUND
  Usage of recombinant human bone morphogenetic protein (rhBMP) in anterior cervical discectomy and fusion (ACDF) procedures is controversial. Studies suggest increased rates of dysphagia, hematoma or seroma, and severe airway compromise in anterior cervical spine procedures using rhBMP. The purpose of the present study was to determine and describe national utilization trends and complication rates associated with rhBMP usage in anterior cervical spine procedures.
  
  
  METHODS
  The MarketScan database from 2006 to 2010 was retrospectively queried to identify 91,543 patients who underwent ACDF with or without cervical corpectomy. Patient selection and outcomes were ascertained with use of ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification) and CPT (Current Procedural Terminology) coding. A total of 3197 patients were treated with rhBMP intraoperatively. Mean follow-up was 588 days (interquartile range [IQR], 205 to 886 days) in the non-treated cohort and 591 days (IQR, 203 to 925 days) in the rhBMP-treated cohort. Multivariate logistic regression as well as propensity score analysis were used to evaluate the association of rhBMP usage with postoperative complications.
  
  
  RESULTS
  In propensity score-adjusted models, rhBMP usage was associated with an increased risk of any complication (odds ratio [OR] = 1.34, 95% confidence interval [CI] = 1.2 to 1.5) and specific complications such as hematoma or seroma (OR = 1.8, 95% CI = 1.4 to 2.3), dysphagia (OR = 1.3, 95% CI = 1.1 to 1.5), and any pulmonary complication (OR = 1.5, 95% CI = 1.2 to 1.8) within thirty days postoperatively. There were no significant differences in the rates of readmission, in-hospital mortality, referral to pain management, new malignancy, or reoperation between the two cohorts. Usage of rhBMP was associated with a mean increase of $5545 (19%) in total payments to the hospital and primary physician (p < 0.001).
  
  
  CONCLUSIONS
  We found an increased overall rate of postoperative complications in patients receiving rhBMP for cervical spinal fusion procedures compared with patients not receiving rhBMP. Hematoma or seroma, pulmonary complications, and dysphagia were also more common in the rhBMP cohort. Usage of rhBMP in a case was associated with $311 greater payments to the surgeon and $4213 greater payments to the hospital.
  
  
  METHODS
  Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive, R291 MC 5327, Stanford, CA 94305-5327. E-mail address for J.K. Ratliff: jratliff@stanford.edu.
authors.forename: Tyler
authors.initials: T
authors.lastname: Cole
authors.affiliation: Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive, R291 MC 5327, Stanford, CA 94305-5327. E-mail address for J.K. Ratliff: jratliff@stanford.edu.
authors.forename: Anand
authors.initials: A
authors.lastname: Veeravagu
authors.affiliation: Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive, R291 MC 5327, Stanford, CA 94305-5327. E-mail address for J.K. Ratliff: jratliff@stanford.edu.
authors.forename: Bowen
authors.initials: B
authors.lastname: Jiang
authors.affiliation: Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive, R291 MC 5327, Stanford, CA 94305-5327. E-mail address for J.K. Ratliff: jratliff@stanford.edu.
authors.forename: John K
authors.initials: JK
authors.lastname: Ratliff
mesh_terms: D000328:Adult; D000368:Aged; D019485:Bone Morphogenetic Proteins / Q000009:adverse effects* / Q000627:therapeutic use; D002574:Cervical Vertebrae / Q000187:drug effects* / Q000503:physiopathology / Q000601:surgery*; D003131:Combined Modality Therapy; D016208:Databases, Factual; D017586:Diskectomy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D012372:ROC Curve; D011994:Recombinant Proteins / Q000627:therapeutic use; D013122:Spinal Diseases / Q000188:drug therapy / Q000601:surgery; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D019485:Bone Morphogenetic Proteins; D011994:Recombinant Proteins