The influence of Covid-19 on utilization of epidural procedures in managing chronic spinal pain in the medicare population

Authors

Laxmaiah Manchikanti, Pain Management Centers of America, Paducah, KY & Evansville, IN.
Vidyasagar Pampati, Pain Management Centers of America, Paducah, KY & Evansville, IN.
Nebojsa Nick Knezevic, Advocate Aurora HealthFollow
Alan D. Kaye, LSU Health Sciences Center, Shreveport, Ochsner Shreveport Hospital and Interventional Pain Clinic Feist-Wieller Cancer Center, Shreveport, LA, USA.
Salahadin Abdi, University of Texas, MD Anderson Cancer Center, Houston, TX.Follow
Mahendra R. Sanapati, Pain Management Centers of America, Paducah, KY & Evansville, IN.
Alaa Abd-Elsayed, UW Health Pain Services and University of Wisconsin School of Medicine and Public Health, Madison, WI.Follow
Radomir Kosanovic, Pain Management Centers of America, Paducah, KY & Evansville, IN.
Amol Soin, Ohio Pain Clinic, Centerville, OH, Wright State University, Dayton, OH.
Douglas P. Beall, Clinical Radiology of Oklahoma, Oklahoma City, OK; and.Follow
Shalini Shah, University of California Irvine, Orange, CA.
Joshua A. Hirsch, Massachusetts General Hospital and Harvard Medical School, Boston, MA.

Recommended Citation

Manchikanti L, Pampati V, Knezevic NN, et al. The Influence of COVID-19 on Utilization of Epidural Procedures in Managing Chronic Spinal Pain in the Medicare Population. Spine (Phila Pa 1976). 2023;48(13):950-961. doi:10.1097/BRS.0000000000004574

Affiliations

Advocate Illinois Masonic Medical Center

Abstract

Study design: A retrospective cohort study of utilization patterns and variables of epidural injections in the fee-for-service (FFS) Medicare population.

Objectives: To update the utilization of epidural injections in managing chronic pain in the FFS Medicare population, from 2000 to 2020, and assess the impact of COVID-19.

Summary of background data: The analysis of the utilization of interventional techniques also showed an annual decrease of 2.5% per 100,000 FFS Medicare enrollees from 2009 to 2018 contrasting to an annual increase of 7.3% from 2000 to 2009. The impact of the COVID-19 pandemic has not been assessed.

Methods: This analysis was performed by utilizing master data from the Centers for Medicare and Medicaid Services (CMS), physician/supplier procedure summary from 2000 to 2020. The analysis was performed by the assessment of utilization patterns using guidance from Strengthening the Reporting of Observational Studies in Epidemiology (STROBE).

Results: Epidural procedures declined at a rate of 19% per 100,000 Medicare enrollees in the FFS Medicare population in the United States from 2019 to 2020, with an annual decline of 3% from 2010 to 2019. From 2000 to 2010, there was an annual increase of 8.3%. This analysis showed a decline in all categories of epidural procedures from 2019 to 2020. The major impact of COVID-19 with closures taking effect from April 1, 2020, through December 31, 2020, will be steeper and rather dramatic, comparing to April 1 to December 31, 2019. However, monthly data from CMS is not available as of now. Overall declines from 2010 to 2019 showed a decrease for cervical and thoracic transforaminal injections with an annual decrease of 5.6%, followed by lumbar interlaminar and caudal epidural injections of 4.9%, followed by 1.8% for lumbar/sacral transforaminal epidurals, and 0.9% for cervical and thoracic interlaminar epidurals.

Conclusion: Declining utilization of epidural injections in all categories was exacerbated to a decrease of 19% from 2019 to 2020 related, in part, to the COVID-19 pandemic. This followed declining patterns of epidural procedures of 3% overall annually from 2010 to 2019.

Level of evidence: 4.

Type

Article

PubMed ID

36728775