Do race, gender, and source of payment impact on anesthetic technique for inguinal hernia repair?

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Background Analyses of existing nationally representative information on how changes in ambulatory orthopedic surgery have affected anesthesia practice over time are rare. We sought to characterize temporal changes in factors surrounding ambulatory orthopedic surgery and anesthesia. Methods Data from the National Survey of Ambulatory Surgery for the years of 1996 and 2006 were analyzed. Entries indicating the performance of knee ligamentoplasty, meniscectomy or shoulder arthroscopy were identified and included in the sample. Temporal changes in a number of variables associated with orthopedic ambulatory surgery were assessed, including: 1) the number of procedures being performed, 2) patient and health care system related demographics and 3) anesthesia related variables. Results Nationwide, the total number of ligamentoplasties, meniscectomies and shoulder arthroscopies increased from 1996 to 2006 by 66% (N=258,932 to N=428,712), 51% (N=456,698 to N=690,164), and 349% (N=93,105 to N=418,188) respectively (P<0.0001). Between 1996 and 2006 the use of peripheral nerve blocks increased from 0.6% to 9.8% for meniscectomies (P<0.0001), from 1.5% to 13.7% for ligamentoplasties (P<0.0001), and from 11.5% to 23.9% for shoulder arthroscopies (P<0.0001), respectively. Neuraxial anesthesia utilization fell from 11.8% to 6.3% for meniscectomies (P<0.0001) and 13.6% to 7.3% for ligamentoplasties (P<0.0001) from 1996 to 2006, respectively. Conclusion Substantial increases in the number of ambulatory knee and shoulder procedures occurred over time, relating to increased demand for anesthesia providers in this field. Trends towards increased use of peripheral nerve blocks may have to be considered by educators when preparing residents for practice.

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confidence: 99%

Changes in Anesthesia-Related Factors in Ambulatory Knee and Shoulder Surgery

Memtsoudis

Kuo²,

et al. 2011

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“…10 The odds of receiving a nerve block more than doubled for those patients with government-supported or private insurance, even after controlling for all other listed effects in our model. These results complement our findings suggesting that metropolitan centers were more likely than their rural counterparts to place nerve blocks, as were freestanding surgical centers over mixed-volume, hospital-based ambulatory surgeries.…”

Section: Discussionmentioning

confidence: 77%

“…7,8 Although lack of health insurance or underinsured status is associated with poor outcomes after multiple types of surgery, the potential role of socioeconomic factors, such as the primary method of payment, on the likelihood of regional anesthesia use and nerve block placement started to emerge only recently. 9,10 It is conceivable that socioeconomic factors may alter the likelihood of nerve block use for ambulatory orthopedic surgery. Despite concerns about increased time requirements for block placement, the improvement in postoperative analgesia with regional anesthetics may increase the perceived value of regional anesthesia over opioid-based therapies for postoperative pain relief among anesthesia providers.…”

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confidence: 99%

Primary Payer Status Is Associated With the Use of Nerve Block Placement for Ambulatory Orthopedic Surgery

Tighe

Brennan

Moser³

et al. 2012

Introduction Although more than 30 million patients in the United States undergo ambulatory surgery each year, it remains unclear what percentage of these patients receive a perioperative nerve block. We reviewed data from the 2006 National Survey of Ambulatory Surgery (NSAS) to determine the demographic, socioeconomic, geographic, and clinical factors associated with the likelihood of nerve block placement for ambulatory orthopedic surgery. The primary outcome of interest was the association between primary method of payment and likelihood of nerve block placement. Additionally, we examined the association between type of surgical procedures, patient demographics, and hospital characteristics with the likelihood of receiving a nerve block. Methods This cross-sectional study reviewed 6,000 orthopedic anesthetics from the 2006 NSAS dataset, which accounted for over 3.9 million orthopedic anesthetics when weighted. The primary outcome of this study addressed the likelihood of receiving a nerve block for orthopedic ambulatory surgery according to the patient’s primary method of payment. Secondary endpoints included differences in demographics, surgical procedures, side effects, complications, recovery profile, anesthesia staffing model, and total perioperative charges in those with and without nerve block. Results Overall, 14.9% of anesthetics in this sample involved a peripheral nerve block. Length of time in postoperative recovery, total perioperative time, and total charges were less for those receiving nerve blocks. Patients were more likely to receive a nerve block if their procedures were performed in metropolitan service areas (OR 1.86, 95% CI 1.19-2.91, p=0.007) or freestanding surgical facilities (OR 2.27, 95% CI 1.74-2.96, p<0.0001), and if payment for their surgery was supported by government programs (OR 2.5, 95% CI 1.01-6.21, p=0.048) or private insurance (OR 2.62, 95% CI 1.12-6.13, p=0.03) versus self-pay or charity care. Conclusion For patients receiving ambulatory orthopedic surgery in the United States, our results suggest that geographic and socioeconomic factors are associated with different likelihoods of perioperative peripheral nerve block placement.

“…For example, some data suggest that racial and socioeconomic disparities exist in the provision of anesthesia, 14 and studies in this arena will have to intensify to reduce such practices if they exist, especially if differential treatments are associated with suboptimal outcomes.…”

Section: Patient Engagementmentioning

confidence: 99%

Anesthesia, Outcomes, and Public Health

Poeran

Mazumdar²,

Memtsoudis

2014

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More than 50 million surgical procedures are performed annually in the United States, with perioperative complications and related long-term adverse outcomes profoundly affecting the nation's health. A growing number of studies recognize that type of anesthesia, a main determinant of perioperative care, is associated with perioperative morbidity and mortality. Emerging data suggest, for example, that anesthesia may be a determinant of cancer recurrence after surgery. Further research is needed to elucidate the impact of anesthesia-related factors on short- and long-term health outcomes. Progress in this area of medicine and its public-health consequences will depend largely on the interest of the public, researchers, and health care policy makers.