Lord Elizabeth L, Cohen Jeremiah R, Buser Zorica, Meisel Hans-Joerg, Brodke Darrel S, Yoon S Tim, Youssef Jim A, Wang Jeffrey C, Park Jong-Beom
University of California at Los Angeles, Los Angeles, CA, USA.
University of Southern California, Los Angeles, CA, USA.
Global Spine J. 2017 Oct;7(7):603-608. doi: 10.1177/2192568217699207. Epub 2017 Aug 17.
Retrospective database review.
After the Food and Drug Administration approved bone morphogenetic protein-2 (BMP) in 2002, BMP was used off-label in the cervical spine to increase bone growth and bony fusion. Since then, concerns have been raised regarding complication rates and safety. This study was conducted to examine the use of BMP in anterior cervical discectomy and fusion (ACDF) in the Medicare population and to determine risk of complications and associated costs within 90 days of surgery.
Patients who underwent ACDF were identified using Current Procedural Terminology (CPT) and International Classification of Diseases, Ninth Revision Procedure codes (ICD9-P). Complications were identified using ICD9 diagnostic codes. Charges were calculated as amount billed, and reimbursements were calculated as amounts paid by Medicare. Data for these analyses came from a nationwide claims database.
A total of 215 047 patients were identified who had ACDF from 2005 to 2011. For the majority of the procedures (89.0%), BMP was not used. BMP use rose from 11.84% in 2005 to a peak of 16.73% in 2007 before decreasing to 12.01% in 2011. BMP was used 16% more in women than men. BMP use was the highest in the West (13.6%) followed by Midwest (11.8%), South (10.6%), and Northeast (7.5%). There was a higher overall complication rate in the BMP group (2.1%) compared with the non-BMP group (1.9%) (odds ratio [OR] = 1.11, 95% CI = 1.01-1.22). The BMP group also had a higher rate of wound complications (0.98% vs 0.76%, OR = 1.29, 95% CI = 1.12-1.48). In this study population, there was no difference in dysphagia/hoarseness, neurologic, medical, or other complications. During the 90-day perioperative period, BMP surgeries were charged at 17.6% higher than non-BMP surgeries.
The use of BMP in ACDF in the Medicare population has decreased since a peak in 2007. The rate of wound and overall complications for BMP use with ACDF was higher than without. Our results regarding dysphagia/hoarseness did not show a statistically meaningful difference, which is in contrast with many other studies. Charges associated with BMP use were higher during the 90-day perioperative period.
回顾性数据库分析。
2002年美国食品药品监督管理局批准骨形态发生蛋白-2（BMP）后，BMP被用于颈椎的非适应证治疗以促进骨生长和骨融合。自那时起，人们对其并发症发生率和安全性产生了担忧。本研究旨在调查医疗保险人群中BMP在前路颈椎间盘切除融合术（ACDF）中的使用情况，并确定手术90天内的并发症风险及相关费用。
使用当前操作术语（CPT）和国际疾病分类第九版手术编码（ICD9-P）识别接受ACDF的患者。使用ICD9诊断编码识别并发症。费用按计费金额计算，报销金额按医疗保险支付金额计算。这些分析的数据来自全国性的索赔数据库。
共识别出2005年至2011年期间接受ACDF的215047例患者。大多数手术（89.0%）未使用BMP。BMP的使用从2005年的11.84%上升至2007年的峰值16.73%，之后在2011年降至12.01%。女性使用BMP的比例比男性高16%。BMP在西部的使用比例最高（13.6%），其次是中西部（11.8%）、南部（10.6%）和东北部（7.5%）。与非BMP组（1.9%）相比，BMP组的总体并发症发生率更高（2.1%）（优势比[OR]=1.11，95%置信区间[CI]=1.01-1.22）。BMP组的伤口并发症发生率也更高（0.98%对0.76%，OR=1.29，95%CI=1.12-1.48）。在该研究人群中，吞咽困难/声音嘶哑、神经、内科或其他并发症方面无差异。在围手术期90天内，BMP手术的收费比非BMP手术高17.6%。
自2007年达到峰值以来，医疗保险人群中ACDF使用BMP的情况有所下降。ACDF使用BMP时的伤口和总体并发症发生率高于未使用时。我们关于吞咽困难/声音嘶哑的结果未显示出统计学上有意义的差异，这与许多其他研究不同。围手术期90天内与使用BMP相关的费用更高。
