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Claims study shows greater hospital charges with BMP use in stenosis surgery
Analysis revealed similar reoperation rates between patients who had fusion with or without BMP.
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GOTHENBURG, Sweden — A retrospective cohort study indicates that rates of outcomes such as 30-day re-hospitalization and major complications were about the same among Medicare patients who underwent lumbar fusion for spinal stenosis regardless of whether bone morphogenetic protein was used intraoperatively.
However, investigators who conducted the study found adjusted hospital charges for cases involving bone morphogenetic proteins (BMPs) averaged $12,000 higher than cases that did not use the proteins.
Study investigator, Richard A. Deyo, MD, MPH, said the results support the short-term safety of BMP in lumbar spine surgery. The study involved about 4-years follow-up of 16,822 patients for reoperations, but complications were only examined during the index hospitalization, so “we can’t comment on long-term complications such as osteolysis, ectopic bone growth or retrograde ejaculation,” he said at the International Society for the Study of the Lumbar Spine Annual Meeting 2011.
Deyo told Orthopedics Today the BMP products used in the study could not be discerned from the Medicare claims data, but “I think it’s fair to assume that most of it was rhBMP-2 (recombinant human BMP-2; Medtronic).” He also noted the study was conducted during an upswing in the use of BMPs in spine surgery.
Discharge to nursing home rates
“Reoperation rates were nearly identical with and without BMP, even after stratifying for previous surgery or surgical complexity, suggesting that this may not be a factor in cost-effectiveness calculations, at least for this age group,” Deyo said.
The team also found no statistically significant differences between BMP and non-BMP treated patients for rates of cardiac and stroke problems, and pulmonary or wound complications. A similar proportion of patients in both groups were re-admitted to the hospital within 30 days of surgery.
“There were significantly fewer discharges to a nursing home among the patients who received BMP,” Deyo said, noting after his presentation that “the lower discharge rates to nursing home is an intriguing finding that actually had been reported in a previous study, as well, which makes it hard to dismiss. It may be because of the bone graft harvesting from the hip. I do not really know what the explanation for that is, but I think it probably deserves some further investigation and certainly might influence a cost-effectiveness analysis.”
Complex vs. simple surgeries
Deyo and colleagues used the Medicare claims database to identify patients aged 68 years or older who had lumbar spinal stenosis fusion surgery in 2003 or 2004. The investigators identified 1,703 patients who had fusions with BMP and 15,119 patients whose cases did not involve BMP.
In addition to evaluating complications, the team assessed the complexity of the surgeries. Procedures that involved more than a single approach to treat more than one or two spinal levels constituted a complex fusion, Deyo noted.
Researchers determined surgeries that were revisions of a primary lumbar operation performed in the prior 3 years using claims data and ICD-9 codes. They also tracked patients through 2008 to determine patients who had a subsequent revision.
“The proportion of patients who received previous lumbar surgery was greater among patients receiving BMP, as was the proportion of patients undergoing complex fusions. Patients who received BMP were also more likely to be undergoing fusion of three or more disc levels,” Deyo said.
Due to the prospective payment system of Medicare, the investigators found that reimbursements for using BMP in these cases slightly exceeded those for not using it, despite higher hospital charges being associated with using the protein. – by Susan M. Rapp
Reference:
- Deyo R, Ching A, Matsen L, et al. Use of bone morphogenetic proteins in spinal fusion surgery for older adults with lumbar stenosis: Trends, complications, repeat surgery, and charges. Paper #P67. Presented at the International Society for the Study of the Lumbar Spine Annual Meeting 2011. June 14-18. Gothenburg, Sweden.
- Richard A. Deyo, MD, MPH, can be reached at the Departments of Family Medicine and Internal Medicine, 3181 S.W. Sam Jackson Park Rd., Portland, OR 97239; 503-494-1694; email: deyor@ohsu.edu.
- Disclosures: Deyo has no relevant financial disclosures. The study was funded by the National Institutes of Health.