Perioperative Medicine  |   November 2019
A Population-based Comparative Effectiveness Study of Peripheral Nerve Blocks for Hip Fracture Surgery
Author Notes
  • From The Ottawa Hospital (G.M.H., M.M.L., R.R., G.L.B., F.W.A., C.J.L.M., D.I.M.); the Departments of Anesthesiology and Pain Medicine (G.M.H., M.M.L., R.R., G.L.B., F.W.A., C.J.L.M., D.I.M.), the Department of Cellular and Molecular Medicine (M.M.L.), the School of Epidemiology and Public Health (D.I.M.), University of Ottawa, Ottawa, Ontario, Canada; the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (M.M.L., R.R., G.L.B., F.W.A., C.J.L.M., D.I.M.); and the Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada (D.I.M.).
  • Submitted for publication November 6, 2018. Accepted for publication July 1, 2019. Corrected on October 1, 2019.
    Submitted for publication November 6, 2018. Accepted for publication July 1, 2019. Corrected on October 1, 2019.×
  • Address correspondence to Dr. McIsaac: Room B311, 1053 Carling Avenue, Ottawa, Ontario K1Y 4E9, Canada. dmcisaac@toh.ca. 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 / Clinical Science / Regional Anesthesia / Quality Improvement
Perioperative Medicine   |   November 2019
A Population-based Comparative Effectiveness Study of Peripheral Nerve Blocks for Hip Fracture Surgery
Anesthesiology 11 2019, Vol.131, 1025-1035. doi:10.1097/ALN.0000000000002947
Anesthesiology 11 2019, Vol.131, 1025-1035. doi:10.1097/ALN.0000000000002947
Abstract

Editor’s Perspective:

What We Already Know about This Topic:

  • Many observational analyses and ongoing randomized trials have evaluated the potential value of neuraxial versus general anesthesia for hip fracture surgery

  • The association between peripheral nerve blocks and outcomes after hip fracture surgery is less well studied

What This Article Tells Us That Is New:

  • Among elderly patients undergoing emergency hip fracture surgery in Ontario, Canada, peripheral nerve blocks may be associated with slightly decreased postoperative lengths of stay and health system costs

  • The use of peripheral nerve blocks was not associated with a difference in postoperative pneumonia rates

Background: Adverse outcomes and resource use rates are high after hip fracture surgery. Peripheral nerve blocks could improve outcomes through enhanced analgesia and decreased opioid related adverse events. We hypothesized that these benefits would translate into decreased resource use (length of stay [primary outcome] and costs), and better clinical outcomes (pneumonia and mortality).

Methods: The authors conducted a retrospective cohort study of hip fracture surgery patients in Ontario, Canada (2011 to 2015) using linked health administrative data. Multilevel regression, instrumental variable, and propensity scores were used to determine the association of nerve blocks with resource use and outcomes.

Results: The authors identified 65,271 hip fracture surgery patients; 10,030 (15.4%) received a block. With a block, the median hospital stay was 7 (interquartile range, 4 to 13) days versus 8 (interquartile range, 5 to 14) days without. Following adjustment, nerve blocks were associated with a 0.6-day decrease in length of stay (95% CI, 0.5 to 0.8). This small difference was consistent with instrumental variable (1.1 days; 95% CI, 0.9 to 1.2) and propensity score (0.2 days; 95% CI, 0.2 to 0.3) analyses. Costs were lower with a nerve block (adjusted difference, −$1,421; 95% CI, −$1,579 to −$1,289 [Canadian dollars]), but no difference in mortality (adjusted odds ratio, 0.99; 95% CI, 0.89 to 1.11) or pneumonia (adjusted odds ratio, 1.01; 95% CI, 0.88 to 1.16) was observed.

Conclusions: Receipt of nerve blocks for hip fracture surgery is associated with decreased length of stay and health system costs, although small effect sizes may not reflect clinical significance for length of stay.