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Significantly lower infection rates, hospital stays found with BMP use for fusion
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SCOTTSDALE, Ariz. — Use of bone morphogenic proteins in anterior and posterior lumbar fusion procedures was significantly associated with shorter hospital stays, lower infection rates and greater in-hospital costs compared to surgeries done without these agents, according to research presented here.
“[Bone morphogenic protein] BMP use in lumbar fusions is common, occurring in more than 50% of anterior lumbar fusions [ALFs] and about a third of posterior lumbar fusions [PLFs],” Steven Fineberg, MD, said during his presentation at the International Society for the Study of the Lumbar Spine Meeting. “Patients in the BMP cohort incurred greater hospital costs and had shorter hospitalizations, which we believe is due to the direct cost of BMP itself. Patients receiving BMP had a lower infection rate than the control group. A possible explanation is that this includes a younger and healthier patient population.”
Steven Fineberg
In their search of the Nationwide Inpatient Sample database, Fineberg and colleagues used ICD-9 codes to identify one- to two-level PLFs (160,970) and ALFs (18,554) performed between 2002 and 2009. BMPs were used in 34.1% of the PLFs and 51% of the ALFs. Due to the large sample size, the investigators used a cut-off of P less than 0.0005 to determine statistical significance.
“Patients receiving BMP were significantly younger, with significantly fewer comorbidities in both groups,” Fineberg said.
In addition to finding significantly shorter hospital stays and higher in-hospital costs in the BMP groups, they found significantly lower infection rates in the BMP cohorts. Although in-hospital complication rates and mortality were lower in the BMP groups, Fineberg noted these findings were not statistically significant.
“Further research is needed to see if there is a protective effect against infection or if there was something confounding our study,” he said.
Reference:
Fineberg S. Paper #47. Presented at: The International Society for the Study of the Lumbar Spine Meeting. May 13-17, 2013; Scottsdale, Ariz.
Disclosure: Fineberg has no relevant financial disclosures.
Perspective
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Scott D. Boden, MD
A lot of the early animal data also suggested a decrease in infection rates so I think that is definitely worth pursuing and trying to see if that pans out in humans. But, there is some reason to believe that may actually be true. The main complications people are trying to sort out right now are cancer, seroma and radiculitis, and that is not possible to determine from the study, which does not have post-discharge follow-up. Then the last comment/question is that although the study did show an increased cost for the bone morphogenetic protein (BMP) group, the increase in cost was well less than the cost of the BMP. So clearly, there most have been some cost-savings even within the hospital experience. I was wondering if the authors looked at what those decreased costs were because the net increase was less than what the cost of the BMP would have been.Click Here to Manage Email Alerts