Acute Airway Obstruction in Cervical Spinal Procedures with Bone Morphogenetic Proteins

Objectives: Bone morphogenetic proteins (BMP) used in anterior cervical spinal procedures causes an inflammatory response resulting in upper-airway obstruction between postoperative days 2 to 7. The purpose of this study is to determine the incidence and severity of complications associated with use of BMP. Study Design: Retrospective cohort study. Methods: This is a retrospective study of 260 patients who underwent cervical spinal procedures with BMP from 2004 to 2009 and a control group of 515 patients who underwent cervical spinal procedures without BMP during the same period at a tertiary care institution. The two groups were compared on hospital length of stay (LOS), hospital charges, incidence of airway obstruction, unplanned intubations after surgery, tracheotomies, intensive care unit (ICU) admissions, hoarseness, dyspnea, respiratory failure, dysphasia, dysphagia, readmissions, and need for percutaneous endoscopic gastrostomy (PEG) tubes. Results: Patients who underwent cervical spine procedures with BMP were noted to have significantly longer hospital stays (P = .001) and higher hospital charges (P = .001) than the control group. Tracheotomies (P = .024), unplanned intubations after surgery (P = .003), dysphagia (P = .001), dyspnea (P = .001), respiratory failure (P = .001), hospital readmissions (P = .040), ICU admissions (P = .001), and 90-day mortality rates (P = .047) were increased for the BMP group. Conclusions: The use of BMP in anterior cervical spinal procedures results in acute airway obstruction due to an extensive soft-tissue inflammatory reaction that is most likely to occur 2 to 7 days after surgery. The increased incidence of unplanned intubations and tracheotomies demonstrates the risk associated with BMP in cervical spinal procedures.