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Study reports sharp rise in use of bone growth factors for spine fusion

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Richard A. Deyo

The use of bone morphogenetic protein for spine fusion surgery has “risen sharply” over the past decade, increasing costs with no evidence of improved outcomes, according to findings from a study in the Feb. 1 issue of Spine.

“[The] results suggest that (bone morphogenetic protein) BMP) may add substantial cost to fusion procedures, with little improvement in subsequent reoperation rates,” Richard A. Deyo, MD, MPH, and co-authors wrote in the study.

Deyo, of Oregon Health & Science University in Portland, Ore., and colleagues identified 16,822 patients in a Medicare database who underwent fusion surgery for lumbar stenosis in 2003 or 2004. They also identified factors associated with BMP use, including major medical complications during index hospitalizations, 30-day rehospitalization rates, and 4-year reoperation rates using Medicare data from 2002 to 2008.

According to the study results, BMP use increased from 5.5% of fusion cases in 2003 to 28.1% of fusion cases in 2008 among 17,000 spine fusions. Patients who had previous surgery were more likely to undergo a procedure using BMP, as well as those who were undergoing complex fusions.

With or without BMP use, Deyo’s team reported that rates of major medical complications, wound complications and 30-day rehospitalizations were all “nearly identical.” Reoperation rates were also noted in the results as being “very similar,” even following stratification for previous surgery or surgical complexity and adjusting for clinical features and demographics.

Spine fusions that used BMP were also considerably more expensive, according to a press release from Spine, with an average $15,000 increase in hospital charges. However, under Medicare’s Diagnosis-Related Group system, the release noted actual reimbursements were “substantially lower,” with an average difference of $850.

“Our findings suggest the value of studying effectiveness in routine care to complement evidence from randomized efficacy trials [and] the importance of studying the effectiveness of new technology in the full range of patient demographics and indications in which it may be used,” Deyo and co-authors wrote.

Reference:

• Deyo RA, 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. Spine. 2012. doi: 10.1097/BRS.0b013e31821bfa3a.

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