Neurological Complication Rates Associated with Epidural Injections (P1.215)

Objective: The purpose of this study is to estimate the incidence of neurological complications associated with epidural injection (EI) and compared these incidences between steroid and non-steroid injections. Background: The Food and Drug Administration (FDA) issued a letter of warning about corticosteroid usage for EIs, which are commonly performed for neck and back pain. The Korean FDA has regulated steroid usage for EI since April, 2013. However, there was no epidemiologic evidence of this regulation. Design/Methods: We used the Health Insurance Record Review & Assessment Service (HIRA) database from 1 January 2009 to 31 December 2013. We made a retrospective cohort to determine the incidence of new neurological complications. We excluded patients who had neuro-rehabilitation under ICD-10 codes of neurological complications. We estimated incidence rates and hazard ratios of neurological complications in propensity score matched cohort stratified by steroids. We used Charlson comorbidity index, age and gender for propensity score matching cohort. We identified the incidence of neurological complications in patients who were admitted to the hospital within 24 hours after an EI at outpatient clinics and received neuro-rehabilitation under ICD-10 codes of neurological complications during admission or death at discharge. Results: Adjusted hazard ratio (HR) for EI with steroid is 1.82 (95% CI 1.58–2.01) compared to one for EI without steroid. Adjusted HR for particulate steroid injections is 1.83 (95% CI 1.53–2.38), compared to one for non-particulate steroid injections. The incidences of neurological complications are 2.37 (person-days, 95% CI, 1.61–4.34) for steroid injections and 1.31 (person-days, 95% CI 0.88–1.51) for injections without steroid at cervicothoracic regions. At lumbosacral regions, the incidences are 1.28 (person-days 95% CI 1.11–1.53) for steroid injections and 0.70 (person-days 95% CI 0.32–0.91) for injections without steroid. Conclusions: After the change of FDA policy for EI, the steroid-usage pattern has been changed. Particulate steroid usage is the main reason of neurological complications. Disclosure: Dr. Hwang has nothing to disclose. Dr. Lee has nothing to disclose. Dr. Park has nothing to disclose.