Newly Published
Perioperative Medicine  |   June 2018
Do Hospitals Performing Frequent Neuraxial Anesthesia for Hip and Knee Replacements Have Better Outcomes?
Author Notes
  • From the Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York (S.G.M., C.C., E.E.M.); Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria (S.G.M., C.C., E.E.M.); Institute for Healthcare Delivery Science, Departments of Population Health Science and Policy (J.P., N.Z., A.O., M.M.), and Departments of Orthopedic Surgery (J.P.) and Medicine (J.P.), Icahn School of Medicine at Mount Sinai, New York, New York; Department of Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (E.R.M.); and Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California (E.R.M).
  • Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).
    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • Submitted for publication January 19, 2017. Accepted for publication April 24, 2018.
    Submitted for publication January 19, 2017. Accepted for publication April 24, 2018.×
  • Research Support: Dr. Memtsoudis is funded by the Anna Maria and Stephen Kellen Career Development Award, Anna Maria and Stephen Kellen Foundation, Inc., New York, New York. Drs. Mazumdar and Poeran are partially funded by the Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
    Research Support: Dr. Memtsoudis is funded by the Anna Maria and Stephen Kellen Career Development Award, Anna Maria and Stephen Kellen Foundation, Inc., New York, New York. Drs. Mazumdar and Poeran are partially funded by the Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York.×
  • Competing Interests: Dr. Memtsoudis is a one-time consultant for Sandoz Inc. (New Jersey) and the holder of U.S. Patent US-2017-0361063, Multicatheter Infusion System. He is the owner of SGM Consulting, LLC (New Jersey). None of the above relations influenced the conduct of the current study. The authors declare no competing interests.
    Competing Interests: Dr. Memtsoudis is a one-time consultant for Sandoz Inc. (New Jersey) and the holder of U.S. Patent US-2017-0361063, Multicatheter Infusion System. He is the owner of SGM Consulting, LLC (New Jersey). None of the above relations influenced the conduct of the current study. The authors declare no competing interests.×
  • Correspondence: Address correspondence to Dr. Memtsoudis: Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, Weill Cornell Medical College, 535 East 70th Street, New York, New York 10021. memtsoudiss@hss.edu. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Regional Anesthesia
Perioperative Medicine   |   June 2018
Do Hospitals Performing Frequent Neuraxial Anesthesia for Hip and Knee Replacements Have Better Outcomes?
Anesthesiology Newly Published on June 6, 2018. doi:10.1097/ALN.0000000000002299
Anesthesiology Newly Published on June 6, 2018. doi:10.1097/ALN.0000000000002299
Abstract

Background: Neuraxial anesthesia is increasingly recommended for hip/knee replacements as some studies show improved outcomes on the individual level. With hospital-level studies lacking, we assessed the relationship between hospital-level neuraxial anesthesia utilization and outcomes.

Methods: National data on 808,237 total knee and 371,607 hip replacements were included (Premier Healthcare 2006 to 2014; 550 hospitals). Multivariable associations were measured between hospital-level neuraxial anesthesia volume (subgrouped into quartiles) and outcomes (respiratory/cardiac complications, blood transfusion/intensive care unit need, opioid utilization, and length/cost of hospitalization). Odds ratios (or percent change) and 95% CI are reported. Volume-outcome relationships were additionally assessed by plotting hospital-level neuraxial anesthesia volume against predicted hospital-specific outcomes; trend tests were applied with trendlines’ R2 statistics reported.

Results: Annual hospital-specific neuraxial anesthesia volume varied greatly: interquartile range, 3 to 78 for hips and 6 to 163 for knees. Increasing frequency of neuraxial anesthesia was not associated with reliable improvements in any of the study’s clinical outcomes. However, significant reductions of up to –14.1% (95% CI, –20.9% to –6.6%) and –15.6% (95% CI, –22.8% to –7.7%) were seen for hospitalization cost in knee and hip replacements, respectively, both in the third quartile of neuraxial volume. This coincided with significant volume effects for hospitalization cost; test for trend P < 0.001 for both procedures, R2 0.13 and 0.41 for hip and knee replacements, respectively.

Conclusions: Increased hospital-level use of neuraxial anesthesia is associated with lower hospitalization cost for lower joint replacements. However, additional studies are needed to elucidate all drivers of differences found before considering hospital-level neuraxial anesthesia use as a potential marker of quality.