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Nerve Block Use after Hip Fracture Versus Elective Hip or Knee Arthroplasty: Retrospective Analysis
OBJECTIVES Although peripheral nerve blocks are associated with improved pain control and end outcomes among older adults with hip fracture, their current utilization among US hip fracture patients is not well understood. We characterized contemporary use of peripheral nerve blocks after hip fractur...
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| Published in: | Journal of the American Geriatrics Society (JAGS) 2020-04, Vol.68 (4), p.835-840 |
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| cites | cdi_FETCH-LOGICAL-c3532-e4854894e769cbe34df88d21d0965d52449a8f978dc690bdbd52d436b3d2c1f03 |
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| container_issue | 4 |
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| container_title | Journal of the American Geriatrics Society (JAGS) |
| container_volume | 68 |
| creator | Neuman, Mark D. Elkassabany, Nabil M. Ochroch, Jason Newcomb, Craig Brensinger, Colleen Mehta, Samir Gaskins, Lakisha J. Lane‐Fall, Meghan B. |
| description | OBJECTIVES
Although peripheral nerve blocks are associated with improved pain control and end outcomes among older adults with hip fracture, their current utilization among US hip fracture patients is not well understood. We characterized contemporary use of peripheral nerve blocks after hip fracture over time and identified predictors of nerve block receipt.
DESIGN
Retrospective cohort study of claims data from one large national private US insurer.
SETTING
US acute care hospitals.
PARTICIPANTS
A total of 94 985 adults aged 50 years and older hospitalized for a femoral neck, intertrochanteric, or subtrochanteric fracture; 409 263 adults aged 50 years and older hospitalized for elective hip or knee arthroplasty between 2004 and 2016.
MEASUREMENTS
Receipt of a peripheral nerve block for pain control, based on Current Procedural Terminology codes in physician service claims.
RESULTS
Overall, 2874 hip fracture patients (3.0%; 95% confidence interval [CI] = 2.9‐3.1) received a nerve block for pain control, and the percentage receiving a block increased from .4% in 2004‐2006 (95% CI = .3%‐.6%) to 4.6% in 2013‐2016 (95% CI = 4.4%‐4.8%; P |
| doi_str_mv | 10.1111/jgs.16362 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2370531647</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2370531647</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3532-e4854894e769cbe34df88d21d0965d52449a8f978dc690bdbd52d436b3d2c1f03</originalsourceid><addsrcrecordid>eNp10LtOwzAUBmALgWgpDLwAssQCQ1vf4jhspeqFi0ACyhol9gmkpE2wE1DfHpcWBiS8WLI__TrnR-iYkh71pz9_cT0quWQ7qE0DzrqBoMEuahNCWFdJKlrowLk5IZQRpfZRizPKRBTyNtJ3YD8AXxalfsMzBzjJarB4mld4bBNdNxbwM1jXODwqQNe5x-vP0uKbJQAe2PrVllWRuHp1gR-gtqWrtm6wTIqVy90h2suSwsHR9u6g2Xj0NJx2b-8nV8PBbVfz9dAgVCBUJCCUkU6BC5MpZRg1JJKBCZgQUaKyKFRGy4ikJvVvRnCZcsM0zQjvoLNNbmXL9wZcHS9yp6EokiWUjYsZD0nAqRShp6d_6LxsrJ93rZSSQcSp8up8o7TfylnI4srmi8SuYkridfOxbz7-bt7bk21iky7A_Mqfqj3ob8BnXsDq_6T4evK4ifwCVuuL9g</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2388659318</pqid></control><display><type>article</type><title>Nerve Block Use after Hip Fracture Versus Elective Hip or Knee Arthroplasty: Retrospective Analysis</title><source>Wiley-Blackwell Read & Publish Collection</source><creator>Neuman, Mark D. ; Elkassabany, Nabil M. ; Ochroch, Jason ; Newcomb, Craig ; Brensinger, Colleen ; Mehta, Samir ; Gaskins, Lakisha J. ; Lane‐Fall, Meghan B.</creator><creatorcontrib>Neuman, Mark D. ; Elkassabany, Nabil M. ; Ochroch, Jason ; Newcomb, Craig ; Brensinger, Colleen ; Mehta, Samir ; Gaskins, Lakisha J. ; Lane‐Fall, Meghan B.</creatorcontrib><description>OBJECTIVES
Although peripheral nerve blocks are associated with improved pain control and end outcomes among older adults with hip fracture, their current utilization among US hip fracture patients is not well understood. We characterized contemporary use of peripheral nerve blocks after hip fracture over time and identified predictors of nerve block receipt.
DESIGN
Retrospective cohort study of claims data from one large national private US insurer.
SETTING
US acute care hospitals.
PARTICIPANTS
A total of 94 985 adults aged 50 years and older hospitalized for a femoral neck, intertrochanteric, or subtrochanteric fracture; 409 263 adults aged 50 years and older hospitalized for elective hip or knee arthroplasty between 2004 and 2016.
MEASUREMENTS
Receipt of a peripheral nerve block for pain control, based on Current Procedural Terminology codes in physician service claims.
RESULTS
Overall, 2874 hip fracture patients (3.0%; 95% confidence interval [CI] = 2.9‐3.1) received a nerve block for pain control, and the percentage receiving a block increased from .4% in 2004‐2006 (95% CI = .3%‐.6%) to 4.6% in 2013‐2016 (95% CI = 4.4%‐4.8%; P < .001). The adjusted odds of receiving a nerve block was lower for patients with vs without dementia (odds ratio [OR] = .88; 95% CI = .80‐.98; P = .02) and among patients aged 75 to 84 vs 64 years or younger (OR = .86; 95% CI = .74‐1.00; P = .02). The odds of nerve block receipt did not vary according to race, ethnicity, fracture location, or most other common comorbidities. Compared with patients with hip fracture, the adjusted odds of nerve block receipt were 2 times higher among patients undergoing elective hip replacement and more than 30 times higher among patients undergoing elective knee replacement.
CONCLUSION
Although use of peripheral nerve blocks for pain control after hip fracture has increased over time, fewer than 5 of every 100 patients hospitalized with hip fracture currently receive a peripheral nerve block, suggesting possible underuse. J Am Geriatr Soc 68:835–840, 2020
See related Editorial by Ellen F. Binder</description><identifier>ISSN: 0002-8614</identifier><identifier>EISSN: 1532-5415</identifier><identifier>DOI: 10.1111/jgs.16362</identifier><identifier>PMID: 32124973</identifier><language>eng</language><publisher>Hoboken, USA: John Wiley & Sons, Inc</publisher><subject>Age Distribution ; Aged ; Aged, 80 and over ; Anesthetics ; Arthroplasty (hip) ; Arthroplasty (knee) ; Arthroplasty, Replacement, Hip - methods ; Arthroplasty, Replacement, Hip - statistics & numerical data ; Arthroplasty, Replacement, Knee - methods ; Arthroplasty, Replacement, Knee - statistics & numerical data ; Case-Control Studies ; Dementia disorders ; Female ; Fractures ; health policy ; Health risk assessment ; Hip ; hip fracture ; Hip Fractures - epidemiology ; Hip Fractures - therapy ; Hospitalization ; Humans ; Joint replacement surgery ; Joint surgery ; Male ; Middle Aged ; Nerve Block - statistics & numerical data ; Pain ; pain management ; Pain Management - methods ; Pain, Postoperative - therapy ; Peripheral nerves ; Retrospective Studies ; surgery ; Terminology</subject><ispartof>Journal of the American Geriatrics Society (JAGS), 2020-04, Vol.68 (4), p.835-840</ispartof><rights>2020 The American Geriatrics Society</rights><rights>2020 The American Geriatrics Society.</rights><rights>2020 American Geriatrics Society and Wiley Periodicals, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3532-e4854894e769cbe34df88d21d0965d52449a8f978dc690bdbd52d436b3d2c1f03</citedby><cites>FETCH-LOGICAL-c3532-e4854894e769cbe34df88d21d0965d52449a8f978dc690bdbd52d436b3d2c1f03</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32124973$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Neuman, Mark D.</creatorcontrib><creatorcontrib>Elkassabany, Nabil M.</creatorcontrib><creatorcontrib>Ochroch, Jason</creatorcontrib><creatorcontrib>Newcomb, Craig</creatorcontrib><creatorcontrib>Brensinger, Colleen</creatorcontrib><creatorcontrib>Mehta, Samir</creatorcontrib><creatorcontrib>Gaskins, Lakisha J.</creatorcontrib><creatorcontrib>Lane‐Fall, Meghan B.</creatorcontrib><title>Nerve Block Use after Hip Fracture Versus Elective Hip or Knee Arthroplasty: Retrospective Analysis</title><title>Journal of the American Geriatrics Society (JAGS)</title><addtitle>J Am Geriatr Soc</addtitle><description>OBJECTIVES
Although peripheral nerve blocks are associated with improved pain control and end outcomes among older adults with hip fracture, their current utilization among US hip fracture patients is not well understood. We characterized contemporary use of peripheral nerve blocks after hip fracture over time and identified predictors of nerve block receipt.
DESIGN
Retrospective cohort study of claims data from one large national private US insurer.
SETTING
US acute care hospitals.
PARTICIPANTS
A total of 94 985 adults aged 50 years and older hospitalized for a femoral neck, intertrochanteric, or subtrochanteric fracture; 409 263 adults aged 50 years and older hospitalized for elective hip or knee arthroplasty between 2004 and 2016.
MEASUREMENTS
Receipt of a peripheral nerve block for pain control, based on Current Procedural Terminology codes in physician service claims.
RESULTS
Overall, 2874 hip fracture patients (3.0%; 95% confidence interval [CI] = 2.9‐3.1) received a nerve block for pain control, and the percentage receiving a block increased from .4% in 2004‐2006 (95% CI = .3%‐.6%) to 4.6% in 2013‐2016 (95% CI = 4.4%‐4.8%; P < .001). The adjusted odds of receiving a nerve block was lower for patients with vs without dementia (odds ratio [OR] = .88; 95% CI = .80‐.98; P = .02) and among patients aged 75 to 84 vs 64 years or younger (OR = .86; 95% CI = .74‐1.00; P = .02). The odds of nerve block receipt did not vary according to race, ethnicity, fracture location, or most other common comorbidities. Compared with patients with hip fracture, the adjusted odds of nerve block receipt were 2 times higher among patients undergoing elective hip replacement and more than 30 times higher among patients undergoing elective knee replacement.
CONCLUSION
Although use of peripheral nerve blocks for pain control after hip fracture has increased over time, fewer than 5 of every 100 patients hospitalized with hip fracture currently receive a peripheral nerve block, suggesting possible underuse. J Am Geriatr Soc 68:835–840, 2020
See related Editorial by Ellen F. Binder</description><subject>Age Distribution</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anesthetics</subject><subject>Arthroplasty (hip)</subject><subject>Arthroplasty (knee)</subject><subject>Arthroplasty, Replacement, Hip - methods</subject><subject>Arthroplasty, Replacement, Hip - statistics & numerical data</subject><subject>Arthroplasty, Replacement, Knee - methods</subject><subject>Arthroplasty, Replacement, Knee - statistics & numerical data</subject><subject>Case-Control Studies</subject><subject>Dementia disorders</subject><subject>Female</subject><subject>Fractures</subject><subject>health policy</subject><subject>Health risk assessment</subject><subject>Hip</subject><subject>hip fracture</subject><subject>Hip Fractures - epidemiology</subject><subject>Hip Fractures - therapy</subject><subject>Hospitalization</subject><subject>Humans</subject><subject>Joint replacement surgery</subject><subject>Joint surgery</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Nerve Block - statistics & numerical data</subject><subject>Pain</subject><subject>pain management</subject><subject>Pain Management - methods</subject><subject>Pain, Postoperative - therapy</subject><subject>Peripheral nerves</subject><subject>Retrospective Studies</subject><subject>surgery</subject><subject>Terminology</subject><issn>0002-8614</issn><issn>1532-5415</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNp10LtOwzAUBmALgWgpDLwAssQCQ1vf4jhspeqFi0ACyhol9gmkpE2wE1DfHpcWBiS8WLI__TrnR-iYkh71pz9_cT0quWQ7qE0DzrqBoMEuahNCWFdJKlrowLk5IZQRpfZRizPKRBTyNtJ3YD8AXxalfsMzBzjJarB4mld4bBNdNxbwM1jXODwqQNe5x-vP0uKbJQAe2PrVllWRuHp1gR-gtqWrtm6wTIqVy90h2suSwsHR9u6g2Xj0NJx2b-8nV8PBbVfz9dAgVCBUJCCUkU6BC5MpZRg1JJKBCZgQUaKyKFRGy4ikJvVvRnCZcsM0zQjvoLNNbmXL9wZcHS9yp6EokiWUjYsZD0nAqRShp6d_6LxsrJ93rZSSQcSp8up8o7TfylnI4srmi8SuYkridfOxbz7-bt7bk21iky7A_Mqfqj3ob8BnXsDq_6T4evK4ifwCVuuL9g</recordid><startdate>202004</startdate><enddate>202004</enddate><creator>Neuman, Mark D.</creator><creator>Elkassabany, Nabil M.</creator><creator>Ochroch, Jason</creator><creator>Newcomb, Craig</creator><creator>Brensinger, Colleen</creator><creator>Mehta, Samir</creator><creator>Gaskins, Lakisha J.</creator><creator>Lane‐Fall, Meghan B.</creator><general>John Wiley & Sons, Inc</general><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7TK</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>202004</creationdate><title>Nerve Block Use after Hip Fracture Versus Elective Hip or Knee Arthroplasty: Retrospective Analysis</title><author>Neuman, Mark D. ; Elkassabany, Nabil M. ; Ochroch, Jason ; Newcomb, Craig ; Brensinger, Colleen ; Mehta, Samir ; Gaskins, Lakisha J. ; Lane‐Fall, Meghan B.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3532-e4854894e769cbe34df88d21d0965d52449a8f978dc690bdbd52d436b3d2c1f03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Age Distribution</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anesthetics</topic><topic>Arthroplasty (hip)</topic><topic>Arthroplasty (knee)</topic><topic>Arthroplasty, Replacement, Hip - methods</topic><topic>Arthroplasty, Replacement, Hip - statistics & numerical data</topic><topic>Arthroplasty, Replacement, Knee - methods</topic><topic>Arthroplasty, Replacement, Knee - statistics & numerical data</topic><topic>Case-Control Studies</topic><topic>Dementia disorders</topic><topic>Female</topic><topic>Fractures</topic><topic>health policy</topic><topic>Health risk assessment</topic><topic>Hip</topic><topic>hip fracture</topic><topic>Hip Fractures - epidemiology</topic><topic>Hip Fractures - therapy</topic><topic>Hospitalization</topic><topic>Humans</topic><topic>Joint replacement surgery</topic><topic>Joint surgery</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Nerve Block - statistics & numerical data</topic><topic>Pain</topic><topic>pain management</topic><topic>Pain Management - methods</topic><topic>Pain, Postoperative - therapy</topic><topic>Peripheral nerves</topic><topic>Retrospective Studies</topic><topic>surgery</topic><topic>Terminology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Neuman, Mark D.</creatorcontrib><creatorcontrib>Elkassabany, Nabil M.</creatorcontrib><creatorcontrib>Ochroch, Jason</creatorcontrib><creatorcontrib>Newcomb, Craig</creatorcontrib><creatorcontrib>Brensinger, Colleen</creatorcontrib><creatorcontrib>Mehta, Samir</creatorcontrib><creatorcontrib>Gaskins, Lakisha J.</creatorcontrib><creatorcontrib>Lane‐Fall, Meghan B.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American Geriatrics Society (JAGS)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Neuman, Mark D.</au><au>Elkassabany, Nabil M.</au><au>Ochroch, Jason</au><au>Newcomb, Craig</au><au>Brensinger, Colleen</au><au>Mehta, Samir</au><au>Gaskins, Lakisha J.</au><au>Lane‐Fall, Meghan B.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Nerve Block Use after Hip Fracture Versus Elective Hip or Knee Arthroplasty: Retrospective Analysis</atitle><jtitle>Journal of the American Geriatrics Society (JAGS)</jtitle><addtitle>J Am Geriatr Soc</addtitle><date>2020-04</date><risdate>2020</risdate><volume>68</volume><issue>4</issue><spage>835</spage><epage>840</epage><pages>835-840</pages><issn>0002-8614</issn><eissn>1532-5415</eissn><abstract>OBJECTIVES
Although peripheral nerve blocks are associated with improved pain control and end outcomes among older adults with hip fracture, their current utilization among US hip fracture patients is not well understood. We characterized contemporary use of peripheral nerve blocks after hip fracture over time and identified predictors of nerve block receipt.
DESIGN
Retrospective cohort study of claims data from one large national private US insurer.
SETTING
US acute care hospitals.
PARTICIPANTS
A total of 94 985 adults aged 50 years and older hospitalized for a femoral neck, intertrochanteric, or subtrochanteric fracture; 409 263 adults aged 50 years and older hospitalized for elective hip or knee arthroplasty between 2004 and 2016.
MEASUREMENTS
Receipt of a peripheral nerve block for pain control, based on Current Procedural Terminology codes in physician service claims.
RESULTS
Overall, 2874 hip fracture patients (3.0%; 95% confidence interval [CI] = 2.9‐3.1) received a nerve block for pain control, and the percentage receiving a block increased from .4% in 2004‐2006 (95% CI = .3%‐.6%) to 4.6% in 2013‐2016 (95% CI = 4.4%‐4.8%; P < .001). The adjusted odds of receiving a nerve block was lower for patients with vs without dementia (odds ratio [OR] = .88; 95% CI = .80‐.98; P = .02) and among patients aged 75 to 84 vs 64 years or younger (OR = .86; 95% CI = .74‐1.00; P = .02). The odds of nerve block receipt did not vary according to race, ethnicity, fracture location, or most other common comorbidities. Compared with patients with hip fracture, the adjusted odds of nerve block receipt were 2 times higher among patients undergoing elective hip replacement and more than 30 times higher among patients undergoing elective knee replacement.
CONCLUSION
Although use of peripheral nerve blocks for pain control after hip fracture has increased over time, fewer than 5 of every 100 patients hospitalized with hip fracture currently receive a peripheral nerve block, suggesting possible underuse. J Am Geriatr Soc 68:835–840, 2020
See related Editorial by Ellen F. Binder</abstract><cop>Hoboken, USA</cop><pub>John Wiley & Sons, Inc</pub><pmid>32124973</pmid><doi>10.1111/jgs.16362</doi><tpages>6</tpages></addata></record> |
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| ispartof | Journal of the American Geriatrics Society (JAGS), 2020-04, Vol.68 (4), p.835-840 |
| issn | 0002-8614 1532-5415 |
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| source | Wiley-Blackwell Read & Publish Collection |
| subjects | Age Distribution Aged Aged, 80 and over Anesthetics Arthroplasty (hip) Arthroplasty (knee) Arthroplasty, Replacement, Hip - methods Arthroplasty, Replacement, Hip - statistics & numerical data Arthroplasty, Replacement, Knee - methods Arthroplasty, Replacement, Knee - statistics & numerical data Case-Control Studies Dementia disorders Female Fractures health policy Health risk assessment Hip hip fracture Hip Fractures - epidemiology Hip Fractures - therapy Hospitalization Humans Joint replacement surgery Joint surgery Male Middle Aged Nerve Block - statistics & numerical data Pain pain management Pain Management - methods Pain, Postoperative - therapy Peripheral nerves Retrospective Studies surgery Terminology |
| title | Nerve Block Use after Hip Fracture Versus Elective Hip or Knee Arthroplasty: Retrospective Analysis |
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