COVID-19 大流行对 2000 年至 2020 年在按服务收费（FFS）医疗保险人群中骶髂关节注射的利用模式的影响。
Impact Of COVID-19 Pandemic and Updated Utilization Patterns of Sacroiliac Joint Injections from 2000 to 2020 in The Fee-For-Service (FFS) Medicare Population.
机构信息
Pain Management Centers of America, Paducah, KY and Evansville, IN; LSU Health Science Center, New Orleans, LA.
Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
出版信息
Pain Physician. 2022 May;25(3):239-250.
BACKGROUND
Among the multiple causes of low back and lower extremity pain, sacroiliac joint pain has shown to be prevalent in 10% to 25% of patients with persistent axial low back pain without disc herniation, discogenic pain, or radiculitis. Over the years, multiple Current Procedural Terminology (CPT) codes have evolved with the inclusion of intraarticular injections, nerve blocks, and radiofrequency neurotomy, in addition to percutaneous sacroiliac joint fusions. Previous assessments of utilization patterns of sacroiliac joint interventions only included sacroiliac joint intraarticular injections, since the data was not available prior to the introduction of new codes. A recent assessment revealed an increase of 11.3%, and an annual increase of 1.2% per 100,000 Medicare population from 2009 to 2018, showing a decline in growth patterns. During the past 2 years, the COVID-19 pandemic has also had significant effects on the utilization patterns of sacroiliac joint interventions.
STUDY DESIGN
The impact of the COVID-19 pandemic and analysis of growth patterns of sacroiliac joint interventions (intraarticular injections, nerve blocks, radiofrequency neurotomy, arthrodesis and fusion) was evaluated from 2010 to 2019 and 2010 to 2020, with a comparative analysis from 2019 to 2020 to assess the impact of the COVID-19 pandemic.
OBJECTIVES
To update utilization patterns of sacroiliac joint interventions with assessment of the impact of the COVID-19 pandemic.
METHODS
The Centers for Medicare and Medicaid Services (CMS) Physician/Supplier Procedure Summary (PSPS) Master dataset was utilized in the present analysis.
RESULTS
The results of this evaluation demonstrated a significant impact of the COVID-19 pandemic with a 19.2% decrease of utilization of sacroiliac joint intraarticular injections from 2019 to 2020. There was a 23.3% increase in sacroiliac joint arthrodesis and a 5.3% decrease for sacroiliac joint fusions with small numbers from 2019 to 2020. However, data was not available for sacroiliac joint nerve blocks and sacroiliac joint radiofrequency neurotomy as these codes were incorporated in 2020. Overall, from 2010 to 2019, sacroiliac joint intraarticular injections showed an annual increase of 0.9% per 100,000 Medicare population. Sacroiliac joint arthrodesis and fusion showed an annual increase from 2010 to 2020 per 100,000 Medicare population of 29% for arthrodesis and 13.3% for fusion.
LIMITATIONS
Limitations of this study include a lack of inclusion of Medicare Advantage patients constituting approximately 30% to 40% of the overall Medicare population. As with all claims-based data analyses, this study is retrospective and thus potentially limited by bias. Finally, patients who are non-Medicare are not part of the dataset.
CONCLUSIONS
The study shows the impact of the COVID-19 pandemic with a significant decrease of intraarticular injections of 19.2% from 2019 to 2020 per 100,000 Medicare population. These decreases of intraarticular injections are accompanied by a 5.3% decrease of fusion, but a 23.3% increase of arthrodesis from 2019 to 2020 per 100,000 Medicare population. Overall, the results showed an annual increase of 0.9% per 100,000 Medicare population for intraarticular injections, a 35.4% annual increase for sacroiliac joint arthrodesis and an increase of 15.5% for sacroiliac joint fusion from 2010 to 2019.
背景
在多种导致下腰痛和下肢痛的原因中，骶髂关节疼痛在没有椎间盘突出、椎间盘源性疼痛或神经根炎的持续性轴向腰痛患者中较为常见，发病率为 10%至 25%。多年来，随着关节内注射、神经阻滞和射频神经切断术的应用，以及经皮骶髂关节融合术的应用，多种当前程序术语 (CPT) 代码不断演变。先前对骶髂关节介入利用模式的评估仅包括骶髂关节关节内注射，因为在新代码引入之前，数据不可用。最近的一项评估显示，从 2009 年到 2018 年，每 10 万医疗保险人群中，骶髂关节介入的利用增加了 11.3%，每年增加 1.2%，表明增长模式有所下降。在过去的两年里，COVID-19 大流行也对骶髂关节介入的利用模式产生了重大影响。
研究设计
评估了 2010 年至 2019 年和 2010 年至 2020 年期间 COVID-19 大流行对骶髂关节介入（关节内注射、神经阻滞、射频神经切断术、融合术和融合术）的影响，并对 2019 年至 2020 年进行了比较分析，以评估 COVID-19 大流行的影响。
目的
更新骶髂关节介入利用模式，并评估 COVID-19 大流行的影响。
方法
本分析使用了医疗保险和医疗补助服务中心 (CMS) 医生/供应商程序摘要 (PSPS) 主数据集。
结果
本评估结果表明，COVID-19 大流行的影响显著，2019 年至 2020 年，骶髂关节关节内注射的利用率下降了 19.2%。2019 年至 2020 年，骶髂关节融合术增加了 23.3%，而骶髂关节融合术则减少了 5.3%。然而，由于这些代码是在 2020 年纳入的，因此没有骶髂关节神经阻滞和骶髂关节射频神经切断术的数据。总体而言，从 2010 年到 2019 年，每 10 万医疗保险人群中，骶髂关节关节内注射的年增长率为 0.9%。2010 年至 2020 年，骶髂关节融合术和融合术的年增长率分别为每 10 万医疗保险人群增加 29%和 13.3%。
局限性
本研究的局限性包括未包括约占总体医疗保险人群 30%至 40%的医疗保险优势患者。与所有基于索赔的数据分析一样，本研究是回顾性的，因此可能受到偏见的限制。最后，非医疗保险患者不在数据集内。
结论
研究表明 COVID-19 大流行的影响显著，2019 年至 2020 年，每 10 万医疗保险人群中，关节内注射减少了 19.2%。这些关节内注射的减少伴随着融合的减少 5.3%，但融合术的增加 23.3%，每 10 万医疗保险人群增加 2019 年至 2020 年。总体而言，2010 年至 2019 年，关节内注射的年增长率为每 10 万医疗保险人群 0.9%，骶髂关节融合术的年增长率为 35.4%，骶髂关节融合术的年增长率为 15.5%。
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