Trends in the use of bone morphogenetic protein-2 in adult spinal deformity surgery: A 10-year analysis of 54 054 patients

Background: Bone morphogenetic protein-2 (BMP-2) is an available bone graft option in spinal fusion surgery. The purpose of this study is to investigate the trends of BMP-2 utilization in adult spinal deformity (ASD) surgery. Methods: The Nationwide Inpatient Sample database from 2002 to 2011 was reviewed. Inclusion criteria were patients over 18 years of age who underwent spinal fusion for ASD. Trends of BMP-2 use were examined over time, as well as stratified based on patient and surgical characteristics. All analyses were done after application of discharge weights to produce national estimates. Results: There were 54 054 patients who met inclusion criteria and were included in this study. The overall rate of BMP-2 use was 39.7% (95% confidence interval 35.0%- 44.3%). Overall, there was steady increase in its use over time, with the highest peak in 2009 (55.3% of all cases used BMP-2), and then a decrease up to 37.9% in 2011 (P < .001). The rate of BMP-2 use was significantly higher for patients older than 54 years of age (compared to patients, 54, P < .001). It was also higher in females (P = .009), Caucasian patients (P = .006), and Medicare patients (P = .006). Its use was 28.6% in the Northeast, 38.1% in the South, 45.2% in the Midwest, and 48.2% in the West (P=.035). Circumferential procedures had the highest rate of BMP-2 use (44.3%, P = .045). Average total hospital charges were S152,403 ± 117,454 for patients who did not receive BMP-2 and $205,426 ± 137,561 for patients who did (P < .001). Conclusion: After analysis of a large nationwide database, it was found that the rate of BMP-2 use in ASD surgery is approximately 40%. There was a significant increase in use from 2002 to 2009, and a decrease thereafter. The highest rates of use were found in older patients, female patients, white patients, Medicare patients, circumferential approaches, and patients undergoing surgery in the Midwest and West regions.