Nationwide practice patterns in the use of recombinant human bone morphogenetic protein-2 in pediatric spine surgery as a function of patient-, hospital-, and procedure-related factors.
OBJECT
Current national patterns as a function of patient-, hospital-, and procedure-related factors, and complication rates in the use of recombinant human bone morphogenetic protein-2 (rhBMP-2) as an adjunct to the practice of pediatric spine surgery have scarcely been investigated.


METHODS
The authors conducted a cross-sectional study using data from the Healthcare Cost and Utilization Project Kids' Inpatient Database. Univariate and multivariate logistic regression were used to calculate unadjusted and adjusted odds ratios and 95% confidence intervals, and p values < 0.05 were considered to be statistically significant.


RESULTS
The authors identified 9538 hospitalizations in pediatric patients 20 years old or younger who had undergone spinal fusion in the US in 2009; 1541 of these admissions were associated with rhBMP-2 use. By multivariate logistic regression, the following factors were associated with rhBMP-2 use: patient age 15-20 years; length of hospital stay (adjusted odds ratio [aOR] 1.01, p = 0.017); insurance status (private [aOR 1.49, p < 0.001] compared with Medicaid); hospital type (nonchildren's hospital); region (Midwest [aOR 2.49, p = 0.008] compared with Northeast); spinal refusion (aOR 2.20, p < 0.001); spinal fusion approach/segment (anterior lumbar [aOR 1.73, p < 0.001] and occipitocervical [aOR 1.86, p = 0.013] compared with posterior lumbar); short segment length (aOR 1.42, p = 0.016) and midlength (aOR 1.44, p = 0.005) compared with long; and preoperative diagnosis (Scheuermann kyphosis [aOR 1.56, p < 0.017] and spondylolisthesis [aOR 1.93, p < 0.001]).


CONCLUSIONS
Use of BMP in pediatric spine procedures now comprises more than 10% of pediatric spinal fusion. Patient-related (age, insurance type, diagnosis); hospital-related (children's hospital vs general hospital, region in the US); and procedure-related (redo fusion, anterior vs posterior approach, spinal levels, number of levels fused) factors are associated with the variation in BMP use in the US.
['Lam|Sandi K|SK|', 'Sayama|Christina|C|', 'Harris|Dominic A|DA|', 'Briceño|Valentina|V|', 'Luerssen|Thomas G|TG|', 'Jea|Andrew|A|']
D000293:Adolescent D055396:Bone Morphogenetic Protein 2 D002574:Cervical Vertebrae D003430:Cross-Sectional Studies D005260:Female D006801:Humans D007902:Length of Stay D016015:Logistic Models D008159:Lumbar Vertebrae D008297:Male D016017:Odds Ratio D010818:Practice Patterns, Physicians' D011994:Recombinant Proteins D012086:Reoperation D013121:Spinal Curvatures D016103:Spinal Fractures D013123:Spinal Fusion D013131:Spine D013168:Spondylolisthesis D013904:Thoracic Vertebrae D016212:Transforming Growth Factor beta D014481:United States D055815:Young Adult
practice patterns pediatric spine DVT = deep venous thrombosis ICD-9-CM = International Classification of Diseases, Ninth Revision, Clinical Modifications KID = Kids' Inpatient Database LOS = length of hospital stay aOR = adjusted odds ratio bone morphogenetic protein rhBMP-2 = recombinant human bone morphogenetic protein–2 spinal instrumentation