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

Abstract

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.

Comparison of general versus isolated regional anesthesia in total shoulder arthroplasty: A retrospective propensity-matched cohort analysis

“…Tighe et al analyzed 3.9 million weighted ambulatory orthopaedic surgery procedures and found that after controlling for covariates, privately-insured patients were 2.62 times more likely to receive a nerve block for analgesic relief than patients with self-care or charity reimbursement. 49 This phenomenon is not unique to orthopaedics, as numerous obstetrics studies have reported that private insurance and higher levels of maternal education are associated with greater rates of epidural anesthesia administration during labor and delivery. 50,51 In our unadjusted analysis, isolated RA was almost exclusively performed at urban, teaching hospitalsa trend that has been previously reported.…”

“…50,51 In our unadjusted analysis, isolated RA was almost exclusively performed at urban, teaching hospitalsa trend that has been previously reported. 52,49 The finding is likely associated with the overwhelming predominance of academic medical centers in urban regions, and the trend of isolated RA being performed primarily at academic centers where fellowship-trained faculty tend to practice. 49,53 With the exception of obesity, major medical comorbidities were more prevalent in patients receiving GA, a finding previously reported in TJA.…”

“…52,49 The finding is likely associated with the overwhelming predominance of academic medical centers in urban regions, and the trend of isolated RA being performed primarily at academic centers where fellowship-trained faculty tend to practice. 49,53 With the exception of obesity, major medical comorbidities were more prevalent in patients receiving GA, a finding previously reported in TJA. 33,54,55 Our observation that obese patients were more likely to receive isolated RA echoes current anesthesia trends, as obesity confers an increased risk of hypoxia in the perioperative setting, 56 and large doses of concomitant opioids associated with GA can significantly increase risk of respiratory depression and post-operative pneumonia in this high-risk cohort.…”

Strategies for daily operating room management of ambulatory surgery centers following resolution of the acute phase of the COVID-19 pandemic

“…Using block areas with registered nurses trained to assist with regional anesthesia reduces operating room time and increases throughput [65][66][67][68][69][70][71][72]. The use of peripheral regional anesthesia reduces how long patients stay in the phase I post-anesthesia care unit [69,73,74] and their time to discharge [75]. Monitored anesthesia care also facilitates bypass of the phase I post-anesthesia care unit [76][77][78].…”

National Trends in Use of Regional Anesthesia and Postoperative Patterns of Opioid Prescription Filling in Shoulder Arthroscopy: A Procedure-Specific Analysis in Patients With or Without Recent Opioid Exposure

“…42 In addition, the fact that most insurance plans will cover a regional nerve block in shoulder arthroscopy cases might have helped in the expansion of this pain management technique. 35 Finally, regional nerve blocks are generally safe, and patients undergoing shoulder arthroscopy seem to be satisfied with their use in clinical practice. 7 Similar to our methodology, previous studies have extracted data from the Humana database to identify the trends in perioperative opioid prescription in patients undergoing shoulder procedures and to explore the risk factors for increased postoperative opioid demand.…”