Regional Anesthesia Is Cost-Effective in Preventing Unanticipated Hospital Admission in Pediatric Patients Having Anterior Cruciate Ligament Reconstruction
Regional Anesthesia Is Cost-Effective in Preventing Unanticipated Hospital Admission in Pediatric Patients Having Anterior Cruciate Ligament Reconstruction
复制标题
区域麻醉对于预防进行前十字韧带重建的儿科患者意外入院具有成本效益
DOI：
10.1097/aap.0000000000000410
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发表时间：
2016
影响因子：
5.1
通讯作者：
K. Boretsky
中科院分区：
文献类型：
--
作者：
Denise Hall;M. Hudson;J. Grudziak;S. Cunningham;K. Boretsky;K. Boretsky
背景和目标已发表的研究表明，区域麻醉 (RA) 在预防成人骨科手术后意外入院 (UHA) 和降低住院费用方面具有益处，但对儿科患者则不然。我们进行了一项回顾性分析，以评估小儿前十字韧带 (ACL) 重建后从阿片类药物转换为基于 RA 的疼痛管理方法的效果。方法回顾ACL重建患者的记录。确定了两组，即有（n = 115）和没有（n = 39）神经阻滞的组。单次阻断或留置导管在手术室 (OR) 或阻断室中进行。记录出院准备时间、术后阿片类药物和止吐药的消耗量、入院或出院以及并发症。计算了提供 RA 的成本、UHA 和麻醉后护理室利用率的变化以及随后的财务影响。结果基于区域麻醉的疼痛管理与较低的 UHA 发生率 (P = 0.045)、较少的麻醉后监护室第二阶段时间 (P = 0.013) 以及阿片类药物消耗量的减少 (P < 0.001) 相关。使用专门的 RA 团队和专用的隔离室可以节省成本或保持中立，而放置在手术室中的 RA 导管会增加直接医院成本。结论 对儿科患者 ACL 修复术后疼痛进行区域麻醉有助于可靠的当天手术出院，并显着减少 UHA。单次块和在手术室外执行的块是最具成本效益的。此外，神经阻滞患者需要更少的阿片类药物，并且可以更快出院。
Background and Objectives Published studies have shown a benefit of regional anesthesia (RA) in preventing unplanned hospital admissions (UHAs) and decreasing hospital costs after orthopedic surgeries in adults but not pediatric patients. We performed a retrospective analysis to assess the effect of converting from an opioid to RA-based approach to pain management after pediatric anterior cruciate ligament (ACL) reconstruction. Methods The records of patients having ACL reconstruction were reviewed. Two groups, those with (n = 115) and without (n = 39) nerve blocks, were identified. Single-shot blocks or indwelling catheters were performed in the operating room (OR) or a block room. Time to discharge readiness, postoperative opiate and antiemetic consumption, hospital admission or discharge, and complications were recorded. The cost of providing RA, the change in UHA and postanesthesia care unit utilization, and subsequent financial impact were calculated. Results Regional anesthesia–based pain management was associated with a lower rate of UHA (P = 0.045), less time in postanesthesia care unit phase II (P = 0.013), and a reduction in opioid consumption (P < 0.001). Use of a dedicated RA team with a dedicated block room resulted in cost savings or neutrality, whereas RA catheters placed in the OR were associated with increased direct hospital costs. Conclusions Regional anesthesia for pain after ACL repair in pediatric patients facilitated reliable same-day surgery discharge and significantly reduced UHAs. Single-shot blocks and blocks performed outside the OR were the most cost-effective. In addition, nerve block patients required less opioids and were ready for discharge sooner.