Complication Rates after Bone Morphogenetic Protein (BMP) Use in Orthopaedic Surgery in Children: A Concise Multicenter Retrospective Cohort Study

Sumeet Garg, James J. McCarthy, Ryan Goodwin, Joel Kolmodin, Wudbhav N. Sankar, Corinna Franklin, Douglas Armstrong, David Fryzel, Susan Hassenbein, Cara Meder

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: The use of bone morphogenetic protein (BMP) has been associated with a number of complications in adult patients. However, this association is less established in children. The aim of this study was to evaluate the safety of BMP use in children by determining the complication rates after BMP use at multiple institutions. Methods: In a retrospective study (2000 to 2013), the medical records of all patients who received BMP at any of the 5 institutions were reviewed. Demographic information, preoperative data, and postoperative follow-up data were collected on those patients who were under the age of 18 at the time of surgery. Results: A total of 312 pediatric patients underwent surgery with BMP application during the study period. The surgical procedures consisted of 228 spinal fusions, 39 pars repairs, 33 nonunion repair, and 12 other various procedures. Overall 21% (65/312) of patients who had BMP utilized had a complication. Fifty-five percent (36/65) of patients with a complication required a revision surgery. The average follow-up was 27 months (range, 3 to 96 mo); 80% of patients had a follow-up period of >12 months. The average age at the time of surgery was 13 years (range, 1 to 17 y). Males and females were almost equally represented in the study: 143 males (46%) and 168 females (54%). Of the patients who received BMP, 9% had minor complications and 13% had major complications. Wound dehiscence without infection was the most common minor complication and occurred in 59% (16/27) of patients with minor complications. Infection and implant failures were the most frequent major complications, occurring in 38% (15/39) and 33% (13/39) of patients with major complications, respectively. Five of 312 (2%) patients had neurological injury, 3 of which were only temporary. Conclusions: This multicenter study demonstrates a relatively high rate of complications after the use of BMP in children. However, further study is needed to attribute the complications directly to the use of BMP. Level of Evidence: Level IV.

Original languageEnglish (US)
Pages (from-to)e375-e378
JournalJournal of Pediatric Orthopaedics
Volume37
Issue number6
DOIs
StatePublished - Jan 1 2017

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Bone Morphogenetic Proteins
Orthopedics
Cohort Studies
Retrospective Studies
Growth Differentiation Factor 2
Spinal Fusion
Wounds and Injuries
Infection
Reoperation
Multicenter Studies
Medical Records
Demography
Pediatrics

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Orthopedics and Sports Medicine

Cite this

Garg, Sumeet ; McCarthy, James J. ; Goodwin, Ryan ; Kolmodin, Joel ; Sankar, Wudbhav N. ; Franklin, Corinna ; Armstrong, Douglas ; Fryzel, David ; Hassenbein, Susan ; Meder, Cara. / Complication Rates after Bone Morphogenetic Protein (BMP) Use in Orthopaedic Surgery in Children : A Concise Multicenter Retrospective Cohort Study. In: Journal of Pediatric Orthopaedics. 2017 ; Vol. 37, No. 6. pp. e375-e378.
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abstract = "Background: The use of bone morphogenetic protein (BMP) has been associated with a number of complications in adult patients. However, this association is less established in children. The aim of this study was to evaluate the safety of BMP use in children by determining the complication rates after BMP use at multiple institutions. Methods: In a retrospective study (2000 to 2013), the medical records of all patients who received BMP at any of the 5 institutions were reviewed. Demographic information, preoperative data, and postoperative follow-up data were collected on those patients who were under the age of 18 at the time of surgery. Results: A total of 312 pediatric patients underwent surgery with BMP application during the study period. The surgical procedures consisted of 228 spinal fusions, 39 pars repairs, 33 nonunion repair, and 12 other various procedures. Overall 21{\%} (65/312) of patients who had BMP utilized had a complication. Fifty-five percent (36/65) of patients with a complication required a revision surgery. The average follow-up was 27 months (range, 3 to 96 mo); 80{\%} of patients had a follow-up period of >12 months. The average age at the time of surgery was 13 years (range, 1 to 17 y). Males and females were almost equally represented in the study: 143 males (46{\%}) and 168 females (54{\%}). Of the patients who received BMP, 9{\%} had minor complications and 13{\%} had major complications. Wound dehiscence without infection was the most common minor complication and occurred in 59{\%} (16/27) of patients with minor complications. Infection and implant failures were the most frequent major complications, occurring in 38{\%} (15/39) and 33{\%} (13/39) of patients with major complications, respectively. Five of 312 (2{\%}) patients had neurological injury, 3 of which were only temporary. Conclusions: This multicenter study demonstrates a relatively high rate of complications after the use of BMP in children. However, further study is needed to attribute the complications directly to the use of BMP. Level of Evidence: Level IV.",
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Complication Rates after Bone Morphogenetic Protein (BMP) Use in Orthopaedic Surgery in Children : A Concise Multicenter Retrospective Cohort Study. / Garg, Sumeet; McCarthy, James J.; Goodwin, Ryan; Kolmodin, Joel; Sankar, Wudbhav N.; Franklin, Corinna; Armstrong, Douglas; Fryzel, David; Hassenbein, Susan; Meder, Cara.

In: Journal of Pediatric Orthopaedics, Vol. 37, No. 6, 01.01.2017, p. e375-e378.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Complication Rates after Bone Morphogenetic Protein (BMP) Use in Orthopaedic Surgery in Children

T2 - A Concise Multicenter Retrospective Cohort Study

AU - Garg, Sumeet

AU - McCarthy, James J.

AU - Goodwin, Ryan

AU - Kolmodin, Joel

AU - Sankar, Wudbhav N.

AU - Franklin, Corinna

AU - Armstrong, Douglas

AU - Fryzel, David

AU - Hassenbein, Susan

AU - Meder, Cara

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N2 - Background: The use of bone morphogenetic protein (BMP) has been associated with a number of complications in adult patients. However, this association is less established in children. The aim of this study was to evaluate the safety of BMP use in children by determining the complication rates after BMP use at multiple institutions. Methods: In a retrospective study (2000 to 2013), the medical records of all patients who received BMP at any of the 5 institutions were reviewed. Demographic information, preoperative data, and postoperative follow-up data were collected on those patients who were under the age of 18 at the time of surgery. Results: A total of 312 pediatric patients underwent surgery with BMP application during the study period. The surgical procedures consisted of 228 spinal fusions, 39 pars repairs, 33 nonunion repair, and 12 other various procedures. Overall 21% (65/312) of patients who had BMP utilized had a complication. Fifty-five percent (36/65) of patients with a complication required a revision surgery. The average follow-up was 27 months (range, 3 to 96 mo); 80% of patients had a follow-up period of >12 months. The average age at the time of surgery was 13 years (range, 1 to 17 y). Males and females were almost equally represented in the study: 143 males (46%) and 168 females (54%). Of the patients who received BMP, 9% had minor complications and 13% had major complications. Wound dehiscence without infection was the most common minor complication and occurred in 59% (16/27) of patients with minor complications. Infection and implant failures were the most frequent major complications, occurring in 38% (15/39) and 33% (13/39) of patients with major complications, respectively. Five of 312 (2%) patients had neurological injury, 3 of which were only temporary. Conclusions: This multicenter study demonstrates a relatively high rate of complications after the use of BMP in children. However, further study is needed to attribute the complications directly to the use of BMP. Level of Evidence: Level IV.

AB - Background: The use of bone morphogenetic protein (BMP) has been associated with a number of complications in adult patients. However, this association is less established in children. The aim of this study was to evaluate the safety of BMP use in children by determining the complication rates after BMP use at multiple institutions. Methods: In a retrospective study (2000 to 2013), the medical records of all patients who received BMP at any of the 5 institutions were reviewed. Demographic information, preoperative data, and postoperative follow-up data were collected on those patients who were under the age of 18 at the time of surgery. Results: A total of 312 pediatric patients underwent surgery with BMP application during the study period. The surgical procedures consisted of 228 spinal fusions, 39 pars repairs, 33 nonunion repair, and 12 other various procedures. Overall 21% (65/312) of patients who had BMP utilized had a complication. Fifty-five percent (36/65) of patients with a complication required a revision surgery. The average follow-up was 27 months (range, 3 to 96 mo); 80% of patients had a follow-up period of >12 months. The average age at the time of surgery was 13 years (range, 1 to 17 y). Males and females were almost equally represented in the study: 143 males (46%) and 168 females (54%). Of the patients who received BMP, 9% had minor complications and 13% had major complications. Wound dehiscence without infection was the most common minor complication and occurred in 59% (16/27) of patients with minor complications. Infection and implant failures were the most frequent major complications, occurring in 38% (15/39) and 33% (13/39) of patients with major complications, respectively. Five of 312 (2%) patients had neurological injury, 3 of which were only temporary. Conclusions: This multicenter study demonstrates a relatively high rate of complications after the use of BMP in children. However, further study is needed to attribute the complications directly to the use of BMP. Level of Evidence: Level IV.

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