Changes in the Utilization of Lumbosacral Epidural Injections Between 2010 and 2019

Abstract

Study Design. A descriptive epidemiologic study. Objective. To analyze trends and patient characteristics for lumbosacral transforaminal and interlaminar/caudal epidural injection utilization over time. Background. Lumbosacral transforaminal and interlaminar/caudal epidural injections are considered for varying lumbar pathologies. Reported studies, physician practices, insurance authorization, and other factors may influence utilization patterns over time. Methods. Patients undergoing lumbosacral transforaminal and interlaminar/caudal epidural injections between 2010 and 2019 were identified in the M91Ortho PearlDiver database based on Current Procedural Terminology coding. Patient age, sex, Elixhauser Comorbidity Index (ECI), insurance plan (commercial, Medicaid, Medicare), and region of the country where the procedure was performed (Midwest, Northeast, South, West) were assessed and tracked over the years studied based on prevalence per 100,000 covered lives. Results. Lumbosacral transforaminal and interlaminar/caudal epidural injections were identified for 426,039 and 501,228 patients, respectively. The number of injections performed per year decreased over the years studied: for transforaminal injections from 160.81 to 76.36 per 100,000 patients and for interlaminar/caudal injections from 200.53 to 77.56 per 100,000 patients. The decrease in overall injections was greatest for those with Commercial and Medicare coverage (53.40% and 66.50%, respectively), with a smaller drop amongst those with Medicaid coverage (32.39%). Over the years, the average patient undergoing injection was older and there was a relative shift toward transforaminal injections (P < 0.05 for both). In terms of specialty of those performing the injections, they were mostly performed by Anesthesiology specialists (who performed less transforaminal than interlaminar/caudal injections). Conclusion. Lumbosacral transforaminal and interlaminar/ caudal spinal epidural injections were shown to decrease by 52.37% per 100,000 patients from 2010 to 2019. Changing demographics of those undergoing such injections and practice patterns are important to consider in the picture of overall spine service utilization. Variations in injection utilization trends by patient insurance raise questions regarding disparities in care.

Femoral Head Core Decompressions: Characterization of Subsequent Conversion to Total Hip Arthroplasty and Related Complications

“…Those without a history of core decompression were matched to those with a history of core decompression 4:1 based on age, sex, and Elixhauser Comorbidity Index (ECI) using methods previously described. 15…”

“…Kaplan-Meier survival curves were constructed to compare 5-year survival with revision, periprosthetic fracture, and dislocation between the matched study groups using methods previously described. 15 A log-rank test was conducted to evaluate any statistically significant difference between the matched study groups for each of these long-term adverse events.…”

“…Those without a history of core decompression were matched to those with a history of core decompression 4:1 based on age, sex, and Elixhauser Comorbidity Index (ECI) using methods previously described. 15 Ninety-day postoperative events were then identified based on ICD, ninth Classification (ICD-9) and ICD-10 coding using methods previously described. Serious adverse events (SAEs) were defined as at least one occurrence of surgical site infection, cardiac arrest, myocardial infarction, sepsis, prosthetic joint infection, venous thromboembolism (pulmonary embolism or deep vein thrombosis), or dislocation.…”

The Burden of Revision Total Ankle Replacement Has Increased From 2010 to 2020

“…This is a well-validated database that has become commonly used for orthopaedic research. 9 - 11 , 27 , 29 PearlDiver data is patient matched at the analysis level but is exported in deidentified and aggregated form. As such, individual patient-level analysis can be performed without compromising patient confidentiality.…”

Steep Decline in Injections

“…Philip Ratnasamy and colleagues utilized the PearlDiver database covering 91 million orthopedic patients across the United States to study trends in the use of these injections. (See Ratnasamy et al, 2022. )…”