Economics of nerve block pain management after anterior cruciate ligament reconstruction - Potential hospital cost savings via associated postanesthesia care unit bypass and same-day discharge
Economics of nerve block pain management after anterior cruciate ligament reconstruction - Potential hospital cost savings via associated postanesthesia care unit bypass and same-day discharge
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DOI：
10.1097/00000542-200403000-00034
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发表时间：
2004-03-01
期刊：
影响因子：
8.8
通讯作者：
Fu, FH
中科院分区：
文献类型：
--
作者：
Williams, BA;Kentor, ML;Fu, FH
背景：前交叉韧带重建术是一种复杂的门诊手术，常伴有疼痛。传统上，手术是在全身麻醉下进行的，通常需要使用PACU。顽固性疼痛和/或恶心/呕吐偶尔会导致计划外住院。在这项研究中，作者研究了这些患者的神经阻滞镇痛的协会，其相关的减少PACU的使用，住院，和hospitalcosts.Methods：这是一项观察性，非随机研究中，现有的数据，患者的手术日的结果合并与医院的成本数据。我们回顾了1995年7月至1999年6月期间在门诊手术室接受前交叉韧带重建术的948名健康男性和女性的连续样本。结果：神经阻滞镇痛的使用与PACU住院率降低至18%和非计划住院率从17%降低至4%相关。多因素线性回归分析显示，旁路PACU患者的住院费用减少了12%（P = 0.0001），而需要住院的患者的住院费用增加了11%（P = 0.0003）。在接受前交叉韧带重建的患者中使用神经阻滞进行急性疼痛管理与PACU旁路和可靠的当天出院相关。虽然这一个程序的成本节约不太可能通过减少人员来产生足够的成本节约，但将这些结果外推到大量的所有类型的侵入性门诊骨科手术可能会产生显着的医院成本节约。
Background: Anterior cruciate ligament reconstruction is a complex outpatient surgical procedure often associated with pain. Traditionally, the procedure is performed under general anesthesia and often requires the use of the PACU. Refractory pain and/or nausea/vomiting occasionally leads to an unplanned hospital admission. In this study, the authors examine the associations of nerve block analgesia for these patients and its associated reductions in PACU use, hospital admission, and hospital costs.Methods: This was an observational, nonrandomized study in which existing data regarding patients' day-of-surgery outcomes were merged with hospital cost data. We reviewed a consecutive sample of 948 men and women who were in good health and underwent anterior cruciate ligament reconstruction in an outpatient surgery unit between July 1995 and June 1999.Results: The use of nerve block analgesia was associated with reduced PACU admissions to 18% and decreased unplanned hospital admission rates from 17% to 4%. Multivariate linear regression analysis showed that patients bypassing the PACU had an associated hospital cost reduction of 12% (P = 0.0001), whereas patients who needed hospital admission had an associated hospital cost increase of 11% (P = 0.0003).Conclusions. The use of nerve blocks for acute pain management in patients undergoing anterior cruciate ligament reconstruction is associated with PACU bypass and reliable same-day discharge. Although the cost savings for this one procedure are unlikely to generate sufficient cost savings via staffing reductions, extrapolating these results to a large volume of all types of invasive outpatient orthopedic procedures may have the potential to create significant hospital cost savings.