P45. Benchmarks of early postoperative epidural steroid injections after posterior lumbar spinal surgery

BACKGROUND CONTEXT Lumbosacral epidural steroid injections (ESI) are a common nonsurgical treatment for pain associated with spinal pathology. While ESI is often considered a conservative management strategy, it is not without costs and risks. However, little is known regarding the incidence of ESI and predictors of this in the early postoperative period following lumbar spinal surgery. PURPOSE We sought to establish benchmarks for the incidence of ESI within 6 months of lumbar surgery and assess potential clinical factors associated with their use. STUDY DESIGN/SETTING Retrospective review of nationally representative administrative claims data from a nationwide insurance database from 2007 to 2017 utilizing the PearlDiver platform. PATIENT SAMPLE The study cohort was comprised of all patients with a prior diagnosis indicating radiculopathy who underwent a 1- or 2-level posterior spinal decompression or fusion. OUTCOME MEASURES The primary outcome measure was incidence of a postoperative ESI within 6 months after lumbar surgery. Postoperative ESI were also measured at 1 and 3 months after surgery. METHODS The incidence of ESI at any time point was calculated as the number of patients receiving an ESI over the number of patients following for that period. The association of surgery type with the incidence of ESI was assessed using chi-squared tests. Then the univariate association of other clinical factors including sex, age, preoperative ESI within 1 year of surgery, and number of preoperative opioid prescriptions within 6 months of surgery, with ESI incidence at 6 months were assessed using chi squared tests. Finally, multivariate associations were assessed using logistic regression. RESULTS In total, 90,702 patients were identified. The ESI incidence was .04% at 1 month, .93% at 3 months, and 3.6% at 6 months postoperatively. The ESI incidence at 6 months varied significantly by surgery with an increased incidence for 1-level compared to 2-level surgeries (4.0% vs. 2.3%, p CONCLUSIONS Lumbar ESI are rare within the first 3 months after a posterior lumbar surgery, however by 6 months 3.6% of patients have received a postoperative ESI. There was an increased incidence of postoperative ESI in patients undergoing 1-level decompressions without fusion. Within the 1-level decompression group, patients who had a preoperative ESI within 1 year of their surgery and patients who received 2 or more opioid prescriptions in the 6 months prior to surgery were more likely to have an ESI by 6 months postoperatively. This work benchmarks norms regarding early postoperative ESI after posterior lumbar procedures. The presence of this population raises questions in regards to the further characterization of patients receiving injections, the efficacy of these procedures, and the effects on long term outcome. FDA DEVICE/DRUG STATUS Unavailable from authors at time of publication.