1602. Insights into complication rates, reoperation rates and health care utilization associated with use of recombinant human bone morphogenetic protein–2 in patients with spine infections.

Authors: Mayur Sharma, MD, MBBS; Nicholas Dietz, MD; Ahmad Alhourani, MD; Beatrice Ugiliweneza; Dengzhi Wang, MS; Doniel Drazin, MD; Maxwell Boakye (Louisville, KY)

Introduction:

Using recombinant human bone morphogenetic protein-2 (rhBMP-2) in patients with spine infections is controversial.The aim was to identify long-term complications, reoperations and healthcare utilization associated with rhBMP-2 use in patients with spine infections.

Methods:

This retrospective study extracted data using ICD9/10 and CPT codes from MarketScan (2000-2016). Patients were dichotomized into two groups (rhBMP-2, non-rhBMP-2) by whether rhBMP-2 was used during fusion surgery for spinal infections. Outcomes of interest: reoperation rates (index level, other levels), readmission rates, discharge disposition, length of stay, complications and healthcare resource utilization at index hospitalization, one-month, 3, 6,12 and 24-months following discharge. Outcomes were compared using non-parametric 2-group tests and generalized linear regression models. 

Results:

Database search identified 2,762 patients with >24 months follow-up.  rhBMP-2 used in 8.4%. Median age: 53years.  52.43% female.  15.11% had Elixhauser comorbidity index 3 or more. Patients in rhBMP-2 group: higher comorbidity indices, incurred higher costs at index hospitalization, mostly discharged home, lower complication rates No difference in complication rates between rhBMP-2 and non-rhBMP-2 groups one-month following discharge.  No difference in reoperation rates between groups at 3, 6, 12 and 24 months following procedure. Patients in non-rhBMP-2 group incurred higher utilization of outpatient services and medication refill costs at 1, 3, 6, 12 and 24-months following surgery.

Conclusion:

rhBMP-2 use was associated with lower complication rates and higher median payments during index hospitalization compared to patients without rhBMP-2 use following surgery for spine infection. There was no difference in reoperation rates (index and other levels) at 3, 6, 12 and 24-months between groups. Patients with rhBMP-2 use incurred lower utilization of outpatient services and overall payments. rhBMP-2 can be used safely in patients with spine infections with cost-effective utilization of health care resources and without an increase in complications or reoperation rates.