Prevalence and Risk Factors of Deep Spinal Infection after Single-shot Epidural Injections: A Nationwide Cohort Study of 3.8 Million Pain Outpatients
Authors' conclusion
Although DSI after single-shot epidural injections is rare, its potential severity underscores the importance of careful patient selection and risk stratification, particularly in older patients, those with comorbidities or immunosuppression, and procedures involving the lumbosacral level.
Study context
- Population
- Patients who underwent single-shot outpatient epidural injections for pain management, Korean National Health Insurance Service database, 2009–201812,049,555 injections
- Participants
- 3,769,014 patients
- Outcome
- Deep spinal infection (DSI): new-onset infection requiring hospitalization and ≥4 weeks of antibiotics
- Follow-up
- Within 90 days of the most recent epidural injection
Methodological detailsnationwide, multivariable logistic regression
- Nationwide
- Multivariable logistic regression
Main finding
As reported in the abstract
Incidence of DSI
Deep spinal infection (DSI) cases
2,422
DSI per injection
0.020%
Observational data: associations, not effects.
Further findings
Risk factors for DSI (multivariable analysis)
| OR (95% CI) | ||
|---|---|---|
| Age 65 yr or older | 1.04 (1.04–1.05) | |
| Peripheral vascular disease | 1.38 (1.07–1.78) | |
| Chronic pulmonary disease | 1.33 (1.11–1.61) | |
| Rheumatologic disease | 1.85 (1.41–2.43) | |
| Peptic ulcer disease | 1.42 (1.22–1.66) | |
| Liver disease | 1.57 (1.34–1.83) | |
| Diabetes | 1.44 (1.14–1.81) | |
| Recent immunosuppressant or systemic steroid use | 2.44 (1.73–3.45) | |
| Three or more injections within 90 days | 1.93 (1.47–2.55) | |
| Lumbosacral-level injections | 1.70 (1.45–2.00) | |
| Selective nerve root blockLower risk of DSI | 0.49 (0.37–0.64) | |
| 0.20.5125Odds ratio (log scale) |
Original publication
Prevalence and Risk Factors of Deep Spinal Infection after Single-shot Epidural Injections: A Nationwide Cohort Study of 3.8 Million Pain Outpatients. Anesthesiology. Published 6 April 2026. doi:10.
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