Use of human recombinant bone morphogenetic protein is associated with increased hospital charges in children with cleft lip and palate having bone graft procedures

Abstract

Purpose: There is wide variation in the timing of secondary alveolar bone grafting in patients with cleft lip and palate. The objective of the present study was to examine the timing and hospitalization outcomes of bone grafting procedures in a cohort of 5- to 13-year-old patients with a diagnosis of cleft lip and palate.

Materials and methods: The Nationwide Inpatient Sample for 2004 to 2010 was used. Outcomes examined included complications, disposition status, hospital charges, and length of stay. Multivariable linear regression analysis was used to examine the association between hospital charges and a group of heterogenous patient-level (age, gender, race, comorbid burden, insurance status, and concomitant procedures) and hospital-level variables.

Results: In total, 3,478 patients underwent bone grafting procedures. Excision of bone for grafting was obtained from pelvic bones in 79.4% of cases. Recombinant bone morphogenetic protein (rhBMP) was inserted in 1% of all cases. Nearly 99% were discharged routinely. The overall complication rate was 1.5%. The mean length of hospital stay was 1.3 days and the mean hospitalization charge was $23,852 per case. Those who had insertion of rhBMP had an excess of $14,695 compared with those who did not have rhBMP after adjustment for all other variables (P<.0001).

Conclusions: Bone grafting procedures are safe when performed in patients 5 to 13 years old. Insertion of rhBMP was performed in nearly 1% of patients undergoing bone grafting procedures. Use of rhBMP was associated with a considerable increase in hospital charges.