Factors associated with hospital admission after rotator cuff repair: the role of peripheral nerve blockade

• Rotator cuff repair is a frequent orthopedic surgery on an ambulatory basis.
• We analyzed more than 27,000 patients undergoing rotator cuff repair.
• Only 15.4% of patients received general anesthesia plus a peripheral nerve block.
• Patients with a peripheral nerve block had 18% reduced risk for hospital admission.
• If hospitalized, costs are approximately 2-fold compared with outpatient costs.

Study objectiveThe objective was to analyze the impact of a peripheral nerve block in addition to general anesthesia on hospital admission after surgical rotator cuff repair.DesignThis was a population-based outcome study. The cost effectiveness of ambulatory rotator cuff repair relies on the discharge of patients on the day of surgery. As the impact of a peripheral nerve block in addition to general anesthesia on this outcome is unknown, we sought to elucidate this subject using population-based data.Patients and methodsInformation on patients undergoing rotator cuff surgery under general anesthesia with or without the addition of a peripheral nerve block (GN vs G) from a retrospective database provided by Premier Perspective, Inc, Charlotte, NC (http://www.premierinc.com), was analyzed. Using multilevel multivariable regressions, we evaluated the independent impact of the type of anesthesia on the outcomes hospital admission, combined major complications, and increased hospital costs.ResultsWe identified 27,201 patients who underwent surgical rotator cuff repair. Approximately 89% (24,240) of patients were discharged on the day of surgery, whereas 11% (2961) were admitted to the hospital. The admission rates for the GN group were 9.1% and 11.2% for the G group (P = .0001). The multivariable regression models showed that patients with the addition of a peripheral nerve block had 18% less risk of being admitted to the hospital (relative risk [RR] = 0.82; 95% confidence interval [CI], 0.74-0.91; P = .0003) compared with those without this intervention. Differences in risk for combined major complications (RR = 1.00; 95% CI, 0.83-1.20; P = .9751) or increased hospital costs (RR = 0.97; 95% CI, 0.93-1.02; P = .2538) were nonsignificant.DiscussionFor patients undergoing surgical rotator cuff repair under general anesthesia, the addition of a peripheral nerve block may be associated with a reduction in the need for postoperative hospital admission after ambulatory surgery. Although the reason for this finding has to remain speculative, better pain control may play a role.