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Utilization of regional anesthesia for open reduction and internal fixation of clavicular fractures is associated with increased same-day discharge and not readmissions
  1. Alexander Beletsky1,
  2. Brittany Nicole Burton2,
  3. Matthew W Swisher3,
  4. John J Finneran IV3 and
  5. Rodney Allanigue Gabriel3,4
  1. 1 School of Medicine, University of California, San Diego, La Jolla, California, USA
  2. 2 Anesthesiology, University of California Los Angeles, Los Angeles, California, USA
  3. 3 Anesthesiology, University of California, San Diego, La Jolla, California, USA
  4. 4 Department of Medicine, Division of Biomedical Informatics, University of California San Diego, La Jolla, CA, United States
  1. Correspondence to Dr Rodney Allanigue Gabriel, Anesthesiology, University of California, San Diego, La Jolla, CA 92093, USA; ragabriel{at}ucsd.edu

Abstract

Background Regional anesthesia is becoming increasingly used for analgesia in clavicular surgery. The purpose of the study is to examine same-day discharge and readmissions in patients with clavicular fractures receiving open reduction and internal fixation, comparing those who received regional anesthesia to those that did not.

Methods The National Surgical Quality Improvement Program registry was used to build a retrospective cohort with the primary and secondary outcomes of same-day discharge and readmission rates, respectively. The independent variable was type of anesthesia (ie, regional vs general). Unadjusted univariable followed by multivariable logistic regression analysis for the association of each covariate with the primary and secondary outcome was performed. A p<0.05 was considered statistically significant.

Results A total of 2300 patients were included, in which 346 (15.0%) of received a nerve block. The only factor associated with same-day discharge on crude analysis was the use of a nerve block (OR 1.70, 95% CI 1.21 to 2.40, p<0.01). Factors not associated with same-day discharge included geriatric age (OR 0.39, 95% CI 0.26 to 0.57, p<0.01), diabetes mellitus (OR 0.54, 95% CI 0.33 to 0.89, p=0.01), dependent functional status (OR 0.27, 95% CI 0.11 to 0.69, p<0.01), hypertension (OR 0.39, 95% CI 0.29 to 0.52, p<0.01), bleeding disorder (OR 0.24, 95% CI 0.10 to 0.59, p<0.01) and an American Society of Anesthesiologists Physical Status score ≥3 (OR 0.33, 95% CI 0.25 to 0.45, p<0.01). On adjusted analysis, regional anesthesia was associated with increased odds of same-day discharge (OR 1.67, 95% CI 1.18 to 2.37, p<0.01), but not 30-day readmission (OR 0.57, 95% CI 0.13 to 2.52, p=0.46).

Conclusion Regional anesthesia use in patients with clavicular fractures is associated with higher odds for same-day discharge. There is no significant difference in the rates of hospital readmission within a 30-day period.

Level of Evidence IV, retrospective case series.

  • upper extremity
  • acute pain
  • nerve block
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Footnotes

  • Contributors AB participated in data collection, analysis, table/figure creation and manuscript preparation. BNB participated in table/figure creation and manuscript preparation. MS participated in table/figure creation and manuscript preparation. JF participated in table/figure creation and manuscript preparation. RAG participated in data collection, analysis, table/figure creation and 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 Our institutional review board approved the study. In the retrospective study, patient data were deidentified and exempt from consent requirements by our institutional review board.

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

  • Data availability statement Data are available in a public, open access repository. NSQIP, https://www.facs.org/quality-programs/acs-nsqip/participant-use.

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