Primary payer status is associated with the use of nerve block placement for ambulatory orthopedic surgery.
Primary payer status is associated with the use of nerve block placement for ambulatory orthopedic surgery.
复制标题
主要付款人状态与门诊骨科手术中神经阻滞放置的使用有关。
DOI：
10.1097/aap.0b013e31824889b6
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发表时间：
2012
影响因子：
5.1
通讯作者：
Bihorac,Azra
中科院分区：
文献类型：
--
作者：
Tighe,PatrickJ;Brennan,Meghan;Moser,Michael;Boezaart,AndreP;Bihorac,Azra
虽然美国每年有超过3000万患者接受门诊手术，但仍不清楚这些患者中有多少百分比接受围手术期神经阻滞。我们回顾了2006年全国门诊手术调查的数据，以确定与门诊骨科手术神经阻滞放置可能性相关的人口统计学、社会经济学、地理和临床因素。主要研究结果是主要支付方式与神经阻滞放置可能性之间的关系。此外，我们研究了外科手术，患者人口统计学类型之间的关联，和医院的特点与可能性接收nerve block.MethodsThis横断面研究回顾了6000骨科麻醉剂从2006年全国调查门诊手术数据集，占超过390万骨科麻醉剂加权时。本研究的主要结局是根据患者的主要支付方式，确定接受骨科门诊手术神经阻滞的可能性。次要终点包括人口统计学差异，外科手术，不良反应，并发症，恢复概况，麻醉人员配置模式，和围手术期总费用与nerve block.ResultsOverall，14.9%的麻醉药在这个样本中涉及周围神经阻滞。接受神经阻滞的患者术后恢复时间、总围手术期时间和总费用较短。如果在大都市服务区进行手术，患者更可能接受神经阻滞（比值比[OR]，1.86; 95%置信区间[CI]，1.19-2.91;P= 0.007）或独立手术机构（OR，2.27; 95%CI，1.74-2.96;P< 0.0001），如果他们的手术费用得到政府项目的支持，（OR，2.5; 95% CI，1.01-6.21;P= 0.048）或私人保险（OR，2.62; 95% CI，1.12-6.13; P= 0.03）与自费或慈善护理。结论对于在美国接受门诊骨科手术的患者，我们的研究结果表明，地理和社会经济因素与围手术期周围神经阻滞放置的不同可能性有关。
IntroductionAlthough more than 30 million patients in the United States undergo ambulatory surgery each year, it remains unclear what percentage of these patients receive a perioperative nerve block. We reviewed data from the 2006 National Survey of Ambulatory Surgery to determine the demographic, socioeconomic, geographic, and clinical factors associated with the likelihood of nerve block placement for ambulatory orthopedic surgery. The primary outcome of interest was the association between primary method of payment and likelihood of nerve block placement. In addition, we examined the association between type of surgical procedures, patient demographics, and hospital characteristics with the likelihood of receiving a nerve block.MethodsThis cross-sectional study reviewed 6000 orthopedic anesthetics from the 2006 National Survey of Ambulatory Surgery data set, which accounted for more than 3.9 million orthopedic anesthetics when weighted. The primary outcome of this study addressed the likelihood of receiving a nerve block for orthopedic ambulatory surgery according to the patient’s primary method of payment. Secondary end points included differences in demographics, surgical procedures, adverse effects, complications, recovery profile, anesthesia staffing model, and total perioperative charges in those with and without nerve block.ResultsOverall, 14.9% of anesthetics in this sample involved a peripheral nerve block. Length of time in postoperative recovery, total perioperative time, and total charges were less for those receiving nerve blocks. Patients were more likely to receive a nerve block if their procedures were performed in metropolitan service areas (odds ratio [OR], 1.86; 95% confidence interval [CI], 1.19–2.91;P= 0.007) or in freestanding surgical facilities (OR, 2.27; 95% CI, 1.74–2.96;P< 0.0001) and if payment for their surgery was supported by government programs (OR, 2.5; 95% CI, 1.01–6.21;P= 0.048) or private insurance (OR, 2.62; 95% CI, 1.12–6.13;P= 0.03) versus self-pay or charity care.ConclusionsFor patients receiving ambulatory orthopedic surgery in the United States, our results suggest that geographic and socioeconomic factors are associated with different likelihoods of perioperative peripheral nerve block placement.