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The Effect of Peripheral Nerve Blocks on Emergency Department Utilization after Upper Extremity Surgery
Scott N. Loewenstein
Ravi Bamba
Joshua Adkinson
Indiana University
2020-02-14
Presenter: Scott Loewenstein
Affidavit:
All of the work in this project represents original work of the resident.
Director Name: William Wooden
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Hand
Introduction:
The purpose of this study was to determine the impact of upper extremity peripheral nerve blocks on emergency department (ED) utilization after hand and upper extremity surgery.
Methods:
We studied a single state's population of outpatient upper extremity surgeries from January 2009 through June 2019 through the Indiana Network for Patient Care and built a database incorporating patient demographics, preoperative comorbidities, concurrent procedures performed, and postoperative ED visit encounter data. We performed univariate, bivariate, and multivariable logistic regression analysis.
Results:
Among 108,451 outpatient surgical patients, 9,079 (8.4%) received blocks. Patients who received blocks varied in race (p<0.001) and had a higher median household income than those that did not ($59,317 versus $56,667, p<0.001). Within two days of surgery, 69 patients (0.8%) who received blocks and 465 patients (0.4%) who did not went to the ED (p<0.001). Postoperative pain was the principal cause of this visit more frequently among patients receiving blocks than not (53.6% versus 35.1%, p<0.001). By postoperative week one, the increased risk returned to baseline. Independent risk factors for ED visits within one week of surgery included peripheral nerve blocks, anxiety, tobacco use, diabetes, heart disease, kidney disease, and recreational drug use (p<0.001) among the variables of race, sex, median income, depression, fibromyalgia, alcohol abuse, hypertension, inflammatory arthritis, osteoarthritis, peripheral vascular disease, lung disease, and liver disease.
Conclusions:
Peripheral nerve blocks produce unnecessary ED resource utilization, which may be prevented through proper patient education. Racial and economic disparities in block use warrant further investigation.
