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Regional Anesthesia and Readmission Rates After Total Knee Arthroplasty

Chi, Debbie, BS*,†; Mariano, Edward R., MD, MAS†,‡; Memtsoudis, Stavros G., MD, PhD§; Baker, Laurence C., PhD‖,¶; Sun, Eric C., MD, PhD†,‖

doi: 10.1213/ANE.0000000000003830
Chronic Pain Medicine: Original Clinical Research Report
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BACKGROUND: Total knee arthroplasty is a commonly performed procedure and an important contributor to national health care spending. Reducing the incidence of readmission could have important consequences for patient well-being and relevant financial implications. Whether regional anesthesia techniques are associated with decreased readmission rates and costs among privately insured patients remains unknown.

METHODS: Using administrative claims data, we identified 138,362 privately insured patients 18–64 years of age who underwent total knee arthroplasty between 2002 and 2013. We then examined whether the use of a nerve block was associated with decreases in readmission rates and related costs during the 90 days after discharge. Our analyses were adjusted for potential confounding variables including medical comorbidities and previous use of opioids and other medications.

RESULTS: After adjusting for patient demographics, comorbidities, and preoperative medication use, the adjusted 90-day readmission rate was 1.8% (95% confidence interval [CI], 1.1–2.4) among patients who did not receive a block compared to 1.7% (95% CI, 1.1–2.4) among patients who did (odds ratio, 0.99; 95% CI, 0.91–1.09; P = .85). The adjusted readmission-related postoperative cost for patients who did not receive a block was $561 (95% CI, 502–619) and $574 (95% CI, 508–639) for patients who did (difference, $13; 95% CI, −75 to 102; P = .74). This lack of statistically significant differences held for subgroup and sensitivity analyses.

CONCLUSIONS: Nerve blocks were not associated with improved measures of long-term postoperative resource use in this younger, privately insured study population.

From the *Icahn School of Medicine at Mount Sinai, New York, New York

Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford University, Stanford, California

Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California

§Department of Anesthesiology, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York

Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California

National Bureau of Economic Research, Cambridge, Massachusetts.

Published ahead of print 24 August 2018.

Accepted for publication August 24, 2018.

Funding: E.C.S. was supported by the National Institute on Drug Abuse (K08DA042314).

Conflicts of Interest: See Disclosures at the end of the article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website.

This work was presented at the Medical Student Anesthesia Research Fellowship (MSARF) symposium at the annual American Society of Anesthesiologists meeting, Boston, MA, October 22, 2017.

Reprints will not be available from the authors.

Address correspondence to Eric C. Sun, MD, PhD, Department of Anesthesiology, Perioperative and Pain Medicine, H3580, Stanford University Medical Center, Stanford, CA 94305. Address e-mail to esun1@stanford.edu.

© 2019 International Anesthesia Research Society
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