Dataset Information

Repeat procedures and prescription opioid use after lumbar medial branch nerve radiofrequency ablation in commercially insured patients.

ABSTRACT: PURPOSE:Although the effectiveness of medial branch nerve radiofrequency ablation (RFA) for lumbosacral facet pain has been described, little is known regarding patterns of repeat RFA utilization and prescription opioid use afterward. DESIGN:Retrospective cohort analysis. PATIENT SAMPLE:Patients undergoing lumbosacral RFA in MarketScan from 2007 to 2016. METHODS:The time until and number of staged RFAs (<180 days after initial RFA) and repeat RFAs (?180 days after initial RFA), as well as opioid use at 90 and 180 days after RFA were assessed. Survival analyses were employed to estimate subsequent RFA rates, whereas subsequent RFA frequencies were estimated with inverse probability weighting. Repeated measures testing was performed comparing opioid use pre- and post-RFA. RESULTS:Initial RFAs were identified in 44,936 patients. Staged RFAs were performed in 33.1% of patients. Repeat RFAs through 1, 3, and 7 years were performed for 14.6%, 33.5%, and 45.7% of patients, respectively. Within 3 years, 12.2% of patients underwent one repeat RFA, whereas 13.2% of patients underwent two or more. Post-RFA opioid use was examined in 128,310 patients, 32.2% of whom used opioids pre-RFA. By 180 days post-RFA, 8.1% of patients discontinued opioids and 6.7% started opioids (p<.001). Exclusively examining pre-RFA opioid users, 24.9% stopped filling opioid prescriptions 180 days after RFA. CONCLUSIONS:This study delineates utilization rates of repeat RFA in the commerciall y insured population, with one-third undergoing repeat RFA within 3 years. Additionally, the present data indicate that lumbosacral RFA is associated with reduced filling of opioid prescriptions through 180 days.

SUBMITTER: Starr JB

PROVIDER: S-EPMC7060813 | biostudies-literature | 2020 Mar

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Repeat procedures and prescription opioid use after lumbar medial branch nerve radiofrequency ablation in commercially insured patients.

Starr Jordan B JB Gold Laura S LS McCormick Zachary Z Suri Pradeep P Friedly Janna J

The spine journal : official journal of the North American Spine Society 20191022 3

<h4>Purpose</h4>Although the effectiveness of medial branch nerve radiofrequency ablation (RFA) for lumbosacral facet pain has been described, little is known regarding patterns of repeat RFA utilization and prescription opioid use afterward.<h4>Design</h4>Retrospective cohort analysis.<h4>Patient sample</h4>Patients undergoing lumbosacral RFA in MarketScan from 2007 to 2016.<h4>Methods</h4>The time until and number of staged RFAs (<180 days after initial RFA) and repeat RFAs (≥180 days after in ...[more]

PMID: 31654808

Similar Datasets

Project description:Background contextLumbar radiofrequency ablation (RFA) is an intervention used to treat facet-mediated chronic low back pain. In some studies with methods consistent with clinical practice guidelines, RFA results in improvements in pain and functional limitations. However, in other studies, RFA demonstrates limited benefit. Despite unanswered questions regarding efficacy of RFA, its use is widespread.PurposeTo describe trends in the utilization and cost of lumbar RFA and lumbar facet injections.Study design/settingRetrospective cohort study.Patient sampleThe sample was derived from the IBM/Watson MarketScan Commercial Claims and Encounters Databases from 2007 to 2016.Outcome measuresLongitudinal trends in the distribution and quantity of lumbar facet injections before lumbar RFA, corticosteroid administration during lumbar facet injections, progression to lumbar RFA after lumbar facet injections, lumbar RFA utilization, and costs of these interventions.MethodsTwo primary cohorts were identified from patients who received lumbar RFA or lumbar facet injection procedures. Utilization rates per 100,000 enrollees were determined for both cohorts. The mean, median, and interquartile ranges of the number of facets targeted and costs per procedure were calculated by year and laterality, as well as overall. Costs in 2018 dollars were estimated by summing gross payment totals from patients and insurance plans. This study was supported by funds from the NIH, and has no conflict of interest associated biases.ResultsFrom 2007 to 2016, lumbar RFA sessions performed per 100,000 enrollees per year increased from 49 to 113, a 130.6% overall increase (9.7% annually). Lumbar facet injection use increased from 201 to 251 sessions per 100,000 enrollees, a 24.9% overall increase (2.5% annually). In the year after a lumbar facet injection, 26.7% of patients received lumbar RFA; 28.6% received another injection but not RFA; and 44.7% received neither. The number of patients receiving two lumbar facet injection procedures prior to lumbar RFA grew from 51.1% in 2010 to 58.8% in 2016. For lumbar RFA, the cost per 100,000 enrollees went from $94,570 in 2007 to $266,680 in 2016, a 12.2% annual increase. For lumbar facet injections, the cost per 100,000 enrollees went from $257,280 in 2007 to $396,580 in 2016, a 4.9% annual increase.ConclusionsThis analysis showed consistent growth in both the frequency and procedure cost of lumbar RFA and facet injections among a large, national, commercially insured population from 2007 to 2016.

Project description:Background:Diagnosis of lumbar facet joint disease is the sum of the combinations consisting of history, physical activity, and diagnostic imaging frequently including computed tomography and magnetic resonance imaging scans. Prevalence of facet-based chronic low back pain is 15-45%. Intra-articular injections with corticosteroid or medial branch block are traditionally used prevalently in the management of chronic low back pain due to lumbar facet joints. However, the evidence levels of these procedures are at either a low or a medium level. Radiofrequency neurolysis of the lumbar medial branch can be used as an alternative in the management of lumbar facet joint pain. There are two types of radiofrequency applications for radiofrequency neurolysis as pulsed radiofrequency and conventional radiofrequency. Materials and Methods:Patients with lumbar facet pain were separated into 2 groups. Group 1 (n=75): patients were given pulsed radiofrequency under fluoroscopy. Group 2 (n=43): patients were given conventional radiofrequency under fluoroscopy. Pre-op and post-op 1st, 3rd, and 6th month and 1st and 2nd year Visual Analogue Scale values of all patients were asked, recorded, and statistically compared. Visual Analogue Scale values of the groups in the same months were compared as well. At the end of the second year, Odom criteria of both groups were recorded and statistically compared. Results:Preoperation Visual Analogue Scale values and postoperation 1st, 3rd, and 6th month and 1st and 2nd year Visual Analogue Scale values were compared in Group 1 and Group 2, and there was a statistically significant difference between preoperation Visual Analogue Scale values and postoperation 1st, 3rd, and 6th month and 1st and 2nd year Visual Analogue Scale values in both groups. However, the number of repetitions of the operation was higher in Group 1. In the comparison of Odom criteria for both groups at the end of the second year, it was observed that the patients in Group 2 were more satisfied with the treatment. Conclusion:Conventional radiofrequency in patients with lumbar facet joint pain for medial branch neurolysis effectively decreases Visual Analogue Scale values in both short and long term. The quality of life and daily activities of patients were better at conventional radiofrequency.

Dataset Information

Repeat procedures and prescription opioid use after lumbar medial branch nerve radiofrequency ablation in commercially insured patients.

Publications

Repeat procedures and prescription opioid use after lumbar medial branch nerve radiofrequency ablation in commercially insured patients.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets