Key result
Peripheral nerve blocks for hip fracture surgery were associated with a 0.6-day decrease in length of stay (95% CI, 0.5 to 0.8) and lower costs, but no difference in mortality or pneumonia.
Why the study?
Adverse outcomes and resource use are high following hip fracture surgery, and it was hypothesized that peripheral nerve blocks could lower resource use and improve clinical outcomes through enhanced analgesia.
Do peripheral nerve blocks reduce length of stay in hip fracture surgery patients?
Cohort (n=65,271)
Yes
Do peripheral nerve blocks reduce length of stay in hip fracture surgery patients?
Mean Difference: -0.6 (95% CI -0.8–-0.5)
Absolute Event Rate: 7% vs 8%
Peripheral nerve blocks for hip fracture surgery are associated with small but statistically significant reductions in length of stay and healthcare costs, without affecting mortality or pneumonia rates.
May shorten stays and cut costs with nerve blocks in hip fracture surgery; leaves open causal effects and need for RCTs.
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.
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Hamilton et al. (2019) conducted a cohort in Hip fracture (n=65,271). Peripheral nerve blocks vs. No nerve block was evaluated on Length of stay (0.6-day decrease, 95% CI 0.5 to 0.8). Peripheral nerve blocks for hip fracture surgery were associated with a 0.6-day decrease in length of stay (95% CI, 0.5 to 0.8) and lower costs, but no difference in mortality or pneumonia.
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