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Peripheral nerve block use in inpatient and outpatient shoulder arthroplasty: a population-based study evaluating utilization and outcomes
  1. Jimmy J Chan1,
  2. Carl M Cirino1,
  3. Luilly Vargas1,
  4. Jashvant Poeran2,
  5. Nicole Zubizarreta2,
  6. Madhu Mazumdar2,
  7. Leesa M Galatz1 and
  8. Paul J Cagle1
  1. 1 Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
  2. 2 Institute for Healthcare Delivery Science, Department of Population Health Science and Policy / Department of Orthopaedic Surgery / Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
  1. Correspondence to Dr Carl M Cirino, Department of Orthopaedics, Mount Sinai Health System, New York, NY 10019, USA; carl.cirino{at}gmail.com

Abstract

Background Peripheral nerve block (PNB) is an effective pain management option after shoulder arthroplasty with increasing popularity over the past decade. Large-scale US data in shoulder arthroplasties are lacking, especially regarding impacts on opioid utilization. This population-based study aimed to evaluate PNB utilization patterns and their effect on outcomes after inpatient and outpatient shoulder arthroplasty.

Methods This retrospective cohort study used data from the nationwide Premier Healthcare claims database (2006–2016). This study includes n=94 787 and n=3293 inpatient and outpatient (total, reverse and partial) shoulder arthroplasty procedures. Multivariable mixed-effects models estimated associations between PNB use and opioid utilization in oral morphine equivalents and cost of hospitalization/stay. For the inpatient group, additional outcome measures were length of stay (LOS), admission to a skilled nurse facility, 30-day readmission, combined complications and naloxone use (as a proxy for opioid-related complications). We report OR (or % change for continuous variables) and 95% CIs.

Results Overall, PNB was used in 19.1% (n=18 144) and 20.8% (n=685) of inpatient and outpatient shoulder arthroplasties, respectively, with an increasing trend for inpatient procedures. PNB utilization was consistently associated with lower (up to −14.0%, 95% CI −15.4% to −12.5% decrease, with median 100 and 90 oral morphine equivalents for inpatient and outpatient procedures) opioid utilization on the day of surgery with more potent effects seen for inpatient shoulder arthroplasties. Other outcomes were minimally impacted.

Discussion In this first national study on PNB use in shoulder arthroplasty, we found increasing PNB use among specifically, inpatient procedures, resulting in particularly reduced opioid use on the day of surgery. While our findings may support PNB use in shoulder arthroplasty, its current low utilization and trends towards more outpatient procedures necessitate continuous monitoring of more extensive benefits.

  • anesthesia, local
  • nerve block
  • pain, postoperative
  • pain management
  • upper extremity
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Footnotes

  • Twitter @jashvant_p

  • Contributors All authors were involved in manuscript preparation.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The Mount Sinai Institutional Review Board (IRB) approved the study, and the IRB waived the requirement for written informed consent as it was considered exempt based on the de-identified HIPAA-compliant nature of the data (project#14–0067).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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