118. Trends in lumbar transforaminal and interlaminar injection utilization from 2010-2019

Abstract

BACKGROUND CONTEXT Lumbar transforaminal and interlaminar injections are considered for varying lumbar pathologies. Reported studies, physician practices, insurance authorization and other factors may influence the utilization of such procedures over time. PURPOSE To analyze trends in lumbar transforaminal and interlaminar spinal injection utilization and associated factors over time. STUDY DESIGN/SETTING A descriptive epidemiologic study. PATIENT SAMPLE 2010-2019 PearlDiver M91Ortho dataset. OUTCOME MEASURES Transforaminal and interlaminar lumbar injections per 100,000 patients in the dataset. METHODS Patients undergoing transforaminal and interlaminar spinal injections were identified based on CPT coding. Patient age, sex, Elixhauser Comorbidity Index (ECI), insurance plan (commercial, Medicaid, Medicare), region of the country where procedure was performed (midwest, northeast, south, west) and average number of injections per patient within a year were abstracted, assessed and tracked over the years studied based on prevalence per 100,000 covered lives. RESULTS In total, transforaminal injections were identified for 426,039 patients, while interlaminar injections were identified in 501,228 patients. For transforaminal injections, the average utilization rate per 100,000 patients decreased between 2010 and 2019 from 160.81 to 76.36. For interlaminar injections, the average utilization per 100,000 patients decreased over the period from 200.53 to 77.56. This 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 age of the injection recipients increased (transforaminal recipients 57.48 to 59.68 years old, interlaminar recipients 57.20 to 60.49 years old, both p < 0.0001). Conversely, the number of injections per patient per year decreased (transforaminal 2.16 to 2.10, interlaminar 2.05 to 1.94, both p < 0.0001). These changes were associated with a shift to more transforaminal relative to interlaminar injections over the years of the study (44.5% to 49.6% transforaminal). Overall, injections were performed most frequently by anesthesiology/pain medicine specialists (who performed less transforaminal than interlaminar inactions), followed distantly by physical medicine and rehabilitation specialists (who performed more transforaminal than interlaminar injection), and those of other specialties performed many fewer injections. CONCLUSIONS Transforaminal and interlaminar spinal epidural injections were shown to decrease by an overall 52.37% from 2010 to 2019. Changes in 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 plan raise questions regarding disparities in care. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs. Lumbar transforaminal and interlaminar injections are considered for varying lumbar pathologies. Reported studies, physician practices, insurance authorization and other factors may influence the utilization of such procedures over time. To analyze trends in lumbar transforaminal and interlaminar spinal injection utilization and associated factors over time. A descriptive epidemiologic study. 2010-2019 PearlDiver M91Ortho dataset. Transforaminal and interlaminar lumbar injections per 100,000 patients in the dataset. Patients undergoing transforaminal and interlaminar spinal injections were identified based on CPT coding. Patient age, sex, Elixhauser Comorbidity Index (ECI), insurance plan (commercial, Medicaid, Medicare), region of the country where procedure was performed (midwest, northeast, south, west) and average number of injections per patient within a year were abstracted, assessed and tracked over the years studied based on prevalence per 100,000 covered lives. In total, transforaminal injections were identified for 426,039 patients, while interlaminar injections were identified in 501,228 patients. For transforaminal injections, the average utilization rate per 100,000 patients decreased between 2010 and 2019 from 160.81 to 76.36. For interlaminar injections, the average utilization per 100,000 patients decreased over the period from 200.53 to 77.56. This 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 age of the injection recipients increased (transforaminal recipients 57.48 to 59.68 years old, interlaminar recipients 57.20 to 60.49 years old, both p < 0.0001). Conversely, the number of injections per patient per year decreased (transforaminal 2.16 to 2.10, interlaminar 2.05 to 1.94, both p < 0.0001). These changes were associated with a shift to more transforaminal relative to interlaminar injections over the years of the study (44.5% to 49.6% transforaminal). Overall, injections were performed most frequently by anesthesiology/pain medicine specialists (who performed less transforaminal than interlaminar inactions), followed distantly by physical medicine and rehabilitation specialists (who performed more transforaminal than interlaminar injection), and those of other specialties performed many fewer injections. Transforaminal and interlaminar spinal epidural injections were shown to decrease by an overall 52.37% from 2010 to 2019. Changes in 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 plan raise questions regarding disparities in care.