Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA 02115, USA.
Spine (Phila Pa 1976). 2011 Dec 15;36(26):2354-62. doi: 10.1097/BRS.0b013e31820bc9e5.
Retrospective analysis of a population-based insurance claims data set.
To determine the risk of repeat fusion and total costs associated with bone morphogenetic protein (BMP) use in single-level lumbar fusion for degenerative spinal disease.
The use of BMP has been proposed to reduce overall costs of spinal fusion through prevention of repeat fusion procedures. Although radiographic fusion rates associated with BMP use have been examined in clinical trials, few data exist regarding outcomes associated with BMP use in the general population.
Using the MarketScan claims data set, 15,862 patients that underwent single-level lumbar fusion from 2003 to 2007 for degenerative disease were identified. Propensity scores were used to match 2372 patients who underwent fusion with BMP to patients who underwent fusion without BMP. Logistic regression models, Kaplan-Meier estimates, and Cox proportional hazards models were used to examine risk of repeat fusion, length of stay, and 30-day readmission by BMP use. Cost comparisons were evaluated with linear regression models using logarithmic transformed data.
At 1 year from surgery, BMP was associated with a 1.1% absolute decrease in the risk of repeat fusion (2.3% with BMP vs. 3.4% without BMP, P = 0.03) and an odds ratio for repeat fusion of 0.66 (95% confidence interval [CI] = 0.47-0.94) after multivariate adjustment. BMP was also associated with a decreased hazard ratio for long-term repeat fusion (adjusted hazards ratio = 0.74, 95% CI = 0.58-0.93). Cost analysis indicated that BMP was associated with initial increased costs for the surgical procedure (13.9% adjusted increase, 95% CI = 9.9%-17.9%) as well as total 1-year costs (10.1% adjusted increase, 95% CI = 6.2%-14.0%).
At 1 year, BMP use was associated with a decreased risk of repeat fusion but also increased health care costs.
基于人群的保险索赔数据集的回顾性分析。
确定在单节段退行性脊柱疾病腰椎融合术中使用骨形态发生蛋白（BMP）的重复融合风险和总费用。
使用 BMP 已被提议通过预防重复融合手术来降低脊柱融合的总体成本。尽管已经在临床试验中检查了与 BMP 使用相关的放射学融合率，但在普通人群中，与 BMP 使用相关的结果数据很少。
使用 MarketScan 索赔数据集，确定了 2003 年至 2007 年间因退行性疾病行单节段腰椎融合术的 15862 例患者。使用倾向评分匹配了 2372 例接受 BMP 融合的患者和 2372 例未接受 BMP 融合的患者。使用逻辑回归模型、Kaplan-Meier 估计和 Cox 比例风险模型检查 BMP 使用与重复融合、住院时间和 30 天再入院的风险。使用对数转换数据的线性回归模型评估成本比较。
在手术 1 年后，BMP 与重复融合风险降低 1.1%（BMP 为 2.3%，无 BMP 为 3.4%，P = 0.03）相关，多变量调整后的重复融合比值比为 0.66（95%置信区间[CI]为 0.47-0.94）。BMP 还与长期重复融合的风险比降低相关（调整后的风险比=0.74，95%CI=0.58-0.93）。成本分析表明，BMP 与手术程序的初始成本增加有关（13.9%的调整增幅，95%CI=9.9%-17.9%）以及 1 年总成本增加（10.1%的调整增幅，95%CI=6.2%-14.0%）。
在 1 年时，BMP 的使用与降低重复融合的风险相关，但也增加了医疗保健成本。
