The Impact of Peripheral Nerve Techniques on Hospital Stay Following Major Orthopedic Surgery

• Published in: Pain medicine (Malden, Mass.) Mass.), 2012-06, Vol.13 (6), p.828-834
• Main Authors: Lenart, Mark J., Wong, Kam, Gupta, Rajnish K., Mercaldo, Nathaniel D., Schildcrout, Jonathan S., Michaels, Damon, Malchow, Randall J.
• Format: Article
• Language: English
• Subjects: Acute Pain; Adult; Aged; Bone surgery; Confidence intervals; Female; Hospital costs; Humans; Length of Stay; Male; Middle Aged; Narcotics; Nerve Block - methods; Opioids; Orthopedic Procedures - adverse effects; Orthopedics; Pain Management; Pain, Postoperative - etiology; Pain, Postoperative - surgery; Patient satisfaction; Patients; Postoperative Pain; Quality of Health Care; Retrospective Studies
• ISSN: 1526-2375; 1526-4637
• DOI: 10.1111/j.1526-4637.2012.01363.x

Objective.  To determine the impact of regional anesthesia on hospital stay for selected orthopedic procedures compared with traditional pain control modalities. Design.  In an era of an increasing volume of orthopedic surgeries, pain modalities that can optimize patient care while minimizing hospital length of stay can have an impact on reducing hospital costs as well as increasing patient satisfaction and improving patient outcomes. Previous studies have shown the potential benefits of regional anesthesia over traditional intravenous (IV) narcotics in meeting these goals in selected orthopedic procedures. Methods.  We retrospectively analyzed the medical records of 494 patients who underwent major orthopedic procedures performed with traditional postoperative pain management alone (IV patient‐controlled analgesia and oral narcotics), single injection peripheral nerve block (PNB), and continuous peripheral nerve block (CPNB) in order to determine the impact that different pain modalities might have on hospital length of stay. Results.  When compared with traditional pain control modalities, single PNB and CPNB were associated with decreased length of hospital stay, though results for specific surgeries varied. The hazard ratios for hospital discharge from a Current Procedural Terminology code‐stratified, covariate (age, gender, and ASA status) adjusted Cox proportional hazards model for single PNB vs no PNB and for CPNB vs no PNB were 1.35 (95% confidence interval: 1.02–1.79) and 1.91 (95% confidence interval: 1.42–2.57), respectively, pointing toward earlier hospital discharge when PNBs were used. Conclusions.  Our retrospective case review showed that, overall, hospital lengths of stay tended to be shorter for orthopedic surgery patients receiving single PNB and CPNB than for those receiving no block and traditional pain management.