Use of Recombinant Bone Morphogenetic Protein Is Associated With Reduced Risk of Reoperation After Spine Fusion for Adult Spinal Deformity.
METHODS
Retrospective review.


OBJECTIVE
This study follows the inpatient-stay administrative data that were collected for a cohort of thousands of patients who had spine fusion surgery in the state of New York. We sought to examine adult spinal deformity (ASD) for reoperation events with and without the use of bone morphogenetic protein-2 (BMP).


BACKGROUND
Randomized controlled trials have suggested that BMP may increase the likelihood of solid arthrodesis in spinal surgery. This would imply fewer reoperations for pseudarthrosis, but small cohort sizes are inadequate to monitor these events.


METHODS
The 2008-2011 New York State Inpatient Database was queried using International Classification of Diseases, Ninth Revision, Clinical Modification codes. Patients age 21 years and older with a diagnosis of scoliosis and an index fusion of greater than 2 spinal motion segments were included. Patient identifiers and linkage variables were used to identify revisits. The relative risk of reoperation was calculated. The use of BMP at the initial inpatient stay was used to define the 2 cohorts for relative risk assessment.


RESULTS
A total of 3751 patients of ASD were identified in 2008. The use of BMP at the initial visit was performed at a rate of 37.6% for ASD. For posterior fusion cases longer than 8 levels, the rate of reoperation for a pseudarthrosis was 23.4%. For ASD fusions greater than 8 levels, the rate of reoperation for pseudarthrosis after using BMP at the index surgery was 5% and 33.9% when BMP was not used, a relative risk of 7.5 (P < 0.001).


CONCLUSIONS
Using relevant inhospital patient records from the New York State Inpatient Sample, we found a 7.5-fold decrease in the risk of reoperation for pseudarthrosis after long fusions when using BMP. Decreased reoperation rates are caused by the improved fusion with the use of BMP. If subsequent unnecessary hospitals stays can be avoided, the economics of BMP use should be reexamined.
*Department of Orthopedic Surgery, New York University Hospital for Joint Diseases, New York City, NY †Department of Orthopedic Surgery, Mount Sinai Beth Israel, New York City, NY.
Justin C
JC
Paul
Baron S
BS
Lonner
Shaleen
S
Vira
Ian David
ID
Kaye
Thomas J
TJ
Errico
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001174:Arthrodesis / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data*; D055396:Bone Morphogenetic Protein 2 / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins / Q000627:therapeutic use; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012600:Scoliosis / Q000601:surgery; D016212:Transforming Growth Factor beta / Q000627:therapeutic use*
D055396:Bone Morphogenetic Protein 2; D011994:Recombinant Proteins; D016212:Transforming Growth Factor beta; C499469:recombinant human bone morphogenetic protein-2