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Original research
Does the impact of peripheral nerve blocks vary by age and comorbidity subgroups? A nationwide population-based study
  1. Haoyan Zhong1,
  2. Jashvant Poeran2,
  3. Crispiana Cozowicz3,
  4. Vassilis Athanassoglou4,
  5. Alex Illescas1,
  6. Stavros G Memtsoudis1,5 and
  7. Jiabin Liu1,5
  1. 1 Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA
  2. 2 Orthopaedics / Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
  3. 3 Department of Anesthesiology and Intensive Care Medicine, Paracelsus Medical Private University, Salzburg, Austria
  4. 4 Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  5. 5 Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA
  1. Correspondence to Dr Jiabin Liu, Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York 10021, USA; liuji{at}hss.edu

Abstract

Introduction A large body of literature suggests that peripheral nerve blockade (PNB) is associated with improved perioperative outcomes in total hip and knee joint arthroplasty patients. However, it is unclear to what extent this association exists across patient subgroups based on age and health status.

Methods Patients who underwent total joint arthroplasty were identified from the Premier Healthcare database (2006–2019). Mixed-effects models were applied to assess the relationship between exposure of interest (PNB use on the day of surgery) and various outcomes (postoperative respiratory complications, acute renal failure, delirium, intensive care unit admission, prolonged length of stay, and high opioid consumption) across multiple subgroups stratified by patient age and pre-existing comorbidities.

Results PNB use and outcome association varies based on the patient’s health and age characteristics. For adults and older adults with excellent or fair, there was a decrease in the likelihood of respiratory complication with the use of PNB (OR: 0.92, 95% CI 0.86 to 0.98; OR: 0.88, 95% CI 0.81 to 0.95; OR: 0.94, 95% CI 0.89 to 0.99, respectively). Peripheral nerve blocks were also associated with a reduction in the odds of high opioid consumption across all categories except adult patients in poor health.

Conclusion PNB use is associated with beneficial effects more commonly observed among patients with a lower comorbidity burden, without a clear pattern of association with patient age.

  • Epidemiology
  • Pain Management
  • REGIONAL ANESTHESIA

Data availability statement

Data may be obtained from a third party and are not publicly available. Data was obtained from a third party (Premier Inc) and are not publicly available.

https://doi.org/10.1136/rapm-2022-104150

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    Data availability statement

    Data may be obtained from a third party and are not publicly available. Data was obtained from a third party (Premier Inc) and are not publicly available.

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    Footnotes

    • Twitter @jashvant_p, @sgmemtsoudis, @jbLiujb

    • Contributors SGM, CC, JL, and JP have helped design the study, conduct the study, analyze the data, and write the manuscript and have approved the final manuscript. HZ and AI have performed the statistical analysis, helped conduct the study, and write the manuscript and have approved the final manuscript. VA have helped conduct the study, analyze the data and write the manuscript and have approved the final manuscript. SGM and JL accepts full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish.

    • 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.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.