A Population-based Comparative Effectiveness Study of Peripheral Nerve Blocks for Hip Fracture Surgery

Abstract

Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Adverse outcomes and resource use rates are high after hip fracture surgery. Peripheral nerve blocks could improve outcomes through enhanced analgesia and decreased opioid related adverse events. We hypothesized that these benefits would translate into decreased resource use (length of stay [primary outcome] and costs), and better clinical outcomes (pneumonia and mortality). Methods The authors conducted a retrospective cohort study of hip fracture surgery patients in Ontario, Canada (2011 to 2015) using linked health administrative data. Multilevel regression, instrumental variable, and propensity scores were used to determine the association of nerve blocks with resource use and outcomes. Results The authors identified 65,271 hip fracture surgery patients; 10,030 (15.4%) received a block. With a block, the median hospital stay was 7 (interquartile range, 4 to 13) days versus 8 (interquartile range, 5 to 14) days without. Following adjustment, nerve blocks were associated with a 0.6-day decrease in length of stay (95% CI, 0.5 to 0.8). This small difference was consistent with instrumental variable (1.1 days; 95% CI, 0.9 to 1.2) and propensity score (0.2 days; 95% CI, 0.2 to 0.3) analyses. Costs were lower with a nerve block (adjusted difference, −$1,421; 95% CI, −$1,579 to −$1,289 [Canadian dollars]), but no difference in mortality (adjusted odds ratio, 0.99; 95% CI, 0.89 to 1.11) or pneumonia (adjusted odds ratio, 1.01; 95% CI, 0.88 to 1.16) was observed. Conclusions Receipt of nerve blocks for hip fracture surgery is associated with decreased length of stay and health system costs, although small effect sizes may not reflect clinical significance for length of stay.

Days alive and at home after hip fracture: a cross-sectional validation of a patient-centred outcome measure using routinely collected data

“…Given the large number of hip fractures that occur, population-level studies of hip fracture care and outcomes are common. [4][5][6][7][8][9] While core outcome sets (ie, an agreed minimum set of outcomes that should be measured and reported in all clinical trials of a specific disease or trial population 10 ) have been developed for patients with hip fracture, mortality is the only core outcome measure typically available in population-level data. 11 12 Furthermore, other routinely available population-level outcomes (eg, length of stay) are not patient-centred.…”

Comparison of Peripheral Nerve Block and Spinal Anesthesia in Terms of Postoperative Mortality and Walking Ability in Elderly Hip Fracture Patients – A Retrospective, Propensity-Score Matched Study

“…7 The present study obtained different results from those conducted in North America, which found that receipt of PNB for hip fracture surgery is associated with decreased LOS and health system costs. 23 We hypothesize that this discrepancy is attributable to differences in health care systems. Chinese patients typically return home after full recovery, rather than transfer to a rehabilitation center in a short period after surgery, which leads to higher cost and prolonged LOS.…”

“… 22 But other studies, conducted as secondary outcomes without adjusted analysis, found no significant difference in 30-day mortality between PNB and non-PNB groups. 13 , 23 It is well known that one common limitation of observational studies is selection bias, a consequence of lack of randomization, which results in higher-risk patients being more likely to undergo one of the interventions due to the theorized benefits. The retrospective studies in question enrolled patients with different types of hip fracture (femoral neck vs intertrochanteric fracture), surgery options (total hip arthroplasty, hemiarthroplasty, and internal fixation), and comorbidities between the PNB and non-PNB groups.…”

Postoperative pain treatment with transmuscular quadratus lumborum block and fascia iliaca compartment block in patients undergoing total hip arthroplasty: a randomized controlled trial

“…Murouchi [ 32 ] et al reported that the peak concentration of ropivacaine after QLB was lower than that of TAPB at a comparable time, and the duration of analgesia was significantly longer. Second, the procedure performed on individuals in group QF further reduced the sensitivity of nerves to surgical stimulation, prevented central and peripheral sensitization, and reduced or eliminated pain caused by nociceptive stimulation [ 33 ]. Last, patients' oral paracetamol 1 g regularly at 6 h intervals after operation also prolonged the time to the first opioid requirement.…”