Regional anesthesia and readmission rates following total knee arthroplasty
Debbie Chi, BS,1,2 Edward R. Mariano, MD MAS,2,3 Stavros G. Memtsoudis, MD PhD,4 Laurence C. Baker, PhD,5,6 and Eric C. Sun, MD PhD2,5Knee
Background.
Total knee arthroplasty is a commonly performed procedure and an important contributor to national healthcare spending. Reducing the incidence of readmission could have important consequences for patient well-being as well as 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 aged 18-64 who underwent total knee arthroplasty between 2002 through 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 following 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% 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 = 0.85). 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=0.74). This lack of statistically significant differences held for subgroup and sensitivity analyses.
Conclusions.
Nerve blocks were not associated with improved measures of longer-term post-operative resource use in this younger, privately insured study population.
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