title: Trends analysis of rhBMP utilization in single-level posterior lumbar fusion (PLF) in the United States.
abstract: OBJECTIVE
  A retrospective database review was carried out to evaluate the trends and demographics of rhBMP utilization in single-level posterior lumbar fusion (PLF) in the United States.
  
  
  METHODS
  Patients who underwent single-level PLF from 2005 to 2011 were identified by searching ICD-9 diagnosis and procedure codes in the PearlDiver Patient Records Database (PearlDiver Technologies, Fort Wayne, IN, USA), a national database of orthopaedic insurance records. The year of procedure, age, gender, and region of the United States were recorded for each patient. Results were reported for each variable as the incidence of procedures identified per 100,000 patients searched in the database.
  
  
  RESULTS
  Totally 5158 patients had single-level PLF in this study. The average rate of single-level PLF with rhBMP utilization maintained at a relatively stable level (19.1-23.5%) from 2005 to 2009, but sharply decreased to 6.8% in 2010 and 6.9% in 2011. The overall incidence of single-level PLF without rhBMP (1.37 cases per 100,000 patients) was more than five times of the incidence of single-level PLF with rhBMP (0.27 cases per 100,000 patients) (P < 0.01). The average rate of single-level PLF with rhBMP utilization is highest in Midwest (18.7%), followed by West (18.4%), South (16.4%) and Northeast (11.5%). The highest incidence of single-level PLF with rhBMP was observed in the group aged 70-74 years with an incidence of 0.33 per 100,000 patients.
  
  
  CONCLUSIONS
  The incidence of rhBMP utilization in single-level PLF increased from 2006 to 2009, but dropped to a low level in 2010 and 2011. The Northeast region had the lowest incidence of rhBMP utilization. The group aged 70-74 years trended to have the higher incidence of single-level PLF with rhBMP utilization.
authors.affiliation: Department of Orthopaedic Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
authors.forename: Lifeng
authors.initials: L
authors.lastname: Lao
authors.affiliation: Department of Orthopaedic Surgery, University of California at Los Angeles (UCLA), Los Angeles, CA, USA.
authors.forename: Jeremiah R
authors.initials: JR
authors.lastname: Cohen
authors.affiliation: Department of Orthopaedic Surgery, University of California at Los Angeles (UCLA), Los Angeles, CA, USA.
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Lord
authors.affiliation: Department of Orthopaedic Surgery, Keck School of Medicine of USC, 1520 San Pablo, HCT Suite 2000, Los Angeles, CA, 90033, USA.
authors.forename: Zorica
authors.initials: Z
authors.lastname: Buser
authors.affiliation: Department of Orthopaedic Surgery, Keck School of Medicine of USC, 1520 San Pablo, HCT Suite 2000, Los Angeles, CA, 90033, USA. jeffrey.wang@med.usc.edu.
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Wang
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D019485:Bone Morphogenetic Proteins / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D016208:Databases, Factual; D004363:Drug Utilization / Q000706:statistics & numerical data / Q000639:trends; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins / Q000627:therapeutic use; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000379:methods*; D014481:United States; D055815:Young Adult
chemical_list: D019485:Bone Morphogenetic Proteins; D011994:Recombinant Proteins
keywords: Demographics; Posterior lumbar fusion; Recombinant human bone morphogenetic protein (rhBMP); Single-level