80 - Comparative Analysis of Health Outcomes Following Image-Guided Minimally Invasive Procedures

Lumbar punctures (LPs) have become the gold standard for CSF sampling and provide important diagnostic value for a wide variety of neurological disorders. However, LP utilization is not without its pitfalls, as complications such as post-LP headaches (PLH) and increased epidural patch utilization can occur. The use of real-time fluoroscopic image guidance has increasingly emerged as a method to reduce such complications and enhance CSF sampling accuracy. However, there are limited studies comparing outcomes between image-guided and non-image-guided LPs in diverse patient populations.
 

Materials and Methods:

We evaluated retrospective insurance claims data in the IBM MarketScan database. Cohorts were stratified dependent on presence of non-image-guided and fluoroscopy-guided LPs. Demographic variables evaluated included gender, neighborhood disadvantaged status as quantified by the National Neighborhood Data Archive, and urbanicity. Chi-square tests (α = 0.01) were used to compare relative proportions of PLH and epidural blood patch utilization within 5 days of undergoing a LP.
 


Results:

In this study, 248,337 patients met inclusion criteria (125,486 non-image-guided and 122,851 image-guided). Compared to the image-guided group, the non-image-guided group had a higher frequency of PLH (8% vs 4%) and patch utilization (4% vs 3% ) with a p-value< 0.0001. Females had more adverse outcomes than males: PLH (8% vs 3%) and patch utilization (4% vs 2%). Inpatient LPs were associated with improved outcomes compared to outpatient LPs: PLH (3% vs 7%) and patch utilization (2% vs 4%). Disadvantaged neighborhoods had similar outcomes compared to advantaged neighborhoods: PLH (6% vs 5%) and patch utilization (4% vs 3%). Additionally, no statistically significant differences were found in comparisons between outcomes in rural-vs-urban neighborhoods.
 


Conclusion:

In conclusion, image-guided LPs were associated with lower rates of adverse events such as PLH and reduced epidural patch utilization. Furthermore, LPs performed outpatient basis and LPs performed on females were both associated with worse outcomes.