Muhammad Talal Ibrahim, James Caid Kirven, Venkat Kavuri, Jayesh Vallabh, Varun Kumar Singh, Elizabeth Yu
Overall, RFA was performed more frequently with lower healthcare utilization after the procedure than SI fusion. Although the gap in procedure frequency narrowed and average reimbursement for RFA decreased over time.
STUDY DESIGN: Retrospective cohort.
OBJECTIVE: To compare trends, healthcare utilization, and costs in surgical sacroiliac (SI) fusion versus radiofrequency ablation (RFA).
SUMMARY OF BACKGROUND DATA: SI joint RFA and surgical SI joint fusion (SI fusion) are 2 possible options to treat refractory SI pain. There is no evidence on practice trends or comparisons of healthcare utilization after these procedures.
METHODS: The PearlDiver database was used to identify RFA and SI fusion cohorts from 2020 to Q1 2023. A sex-based subgroup analysis was also conducted. Outcome measures were quarterly trends, reimbursements, and healthcare utilization [physical therapy, office visits, emergency department (ED) visits, computed tomography (CT) scans, magnetic resonance imaging (MRI) scans, opioid prescriptions, and nonsteroidal anti-inflammatory drugs (NSAIDs)].
RESULTS: This study included 20,448 patients: 12,581 (62.8%) in the RFA cohort and 7597 (37.2%) in the SI fusion cohort. Of the patients, 69.8% were female. The RFA cohort was older, had diabetes, a high Elixhauser-Comorbidity Index (ECI), and lower family income. The total number of RFA procedures per quarter has consistently exceeded that of SI fusions, though the gap has narrowed. From Q1 2020 to Q1 2023, the number of RFAs decreased by an average of 155 procedures per quarter, while SI fusions increased by an average of 331 procedures per quarter. Healthcare utilization was higher after SI fusion in physical therapy (36.4% vs. 18.4%, P<0.001), ED visits (28.1% vs. 25.5%, P<0.001), CT scans (15.4% vs. 4.9%, P<0.001), and opioid prescriptions (76.4% vs. 60.5%, P<0.001), while lower in office visits (86.0% vs 90.6%, P<0.001) as compared with RFA.
CONCLUSION: Overall, RFA was performed more frequently with lower healthcare utilization after the procedure than SI fusion. Although the gap in procedure frequency narrowed and average reimbursement for RFA decreased over time.
LEVEL OF EVIDENCE: Level III.