Index Hospital Costs and Postoperative Outcomes of Lumbar Spine Fusion With FIBERGRAFT Vs Bone Morphogenic Protein-2:...

There are limited data available to understand the value of bioactive glass for spinal fusion procedures. Bone morphogenic protein-2 (BMP-2) is an established graft that has been on the market for roughly 24 years, while bioactive glass represents a newer class of graft technology. The objective of this study is to compare economic, health care utilization, and postoperative outcomes associated with the use of a bioactive glass vs BMP-2.

A retrospective, comparative study was conducted to compare a bioactive glass, FIBERGRAFT (DePuy Synthes, Raynham, MA), to BMP-2. The Premier hospital billing database was used. Patients who underwent lumbar fusion from 2016 to 2024 with bioactive glass or BMP-2 were included. The primary study outcome was index hospital cost. The exploratory outcomes were length of stay, operation room time, and 1-year pseudarthrosis, spinal infection overall (defined as the presence of spinal infection or surgical site infection), and surgical site infection only. Patients in each graft group were balanced using propensity score matching. Analyses were conducted for the overall cohort (primary) and, as a sensitivity analysis, for a subset of patients based on primary procedure and diagnosis.

The group sizes for each cohort before balancing were 1,013 and 59,394 patients for bioactive glass and BMP-2, respectively. After matching, the group sizes for both grafts were 1013 patients for a total of 2026 patients in the matched cohort. In the matched cohort, 65 to 74 years was the most frequent age group (34% in each cohort), and more than half were women (57% bioactive glass, 56% BMP-2). The mean (95% CI) index hospital costs were $40,187 ($39,132, $41,241) for bioactive glass and $45,010 ($43,809, $46,211) for BMP-2, representing a mean difference (95% CI) of -$4823 ($-6382, $-3265), P < 0.001. The exploratory endpoints were similar for both grafts. Both the primary and sensitivity analyses demonstrated consistent results.

This study suggests that patients who undergo lumbar fusion with bioactive glass have lower index costs and similar health care resource utilization and postoperative outcomes compared with those who receive BMP-2. Results from this study may help payers, health care systems, and providers make value-based decisions regarding product utilization.

This research provides an understanding of hospital costs, health care resource utilization, and 1-year outcomes of bioactive glass used in lumbar fusion surgery using a comparative study design.