Socioeconomic, Patient, and Hospital Determinants for the Utilization of Peripheral Nerve Blocks in Total Joint Arthroplasty
Authors' conclusion
Among THA and TKA patients on Medicare, large variations exist in the utilization of PNBs by clinical and hospital variables, while demographic and socioeconomic variables played a limited role.
Study context
- Population
- Medicare patients undergoing total hip or knee arthroplasty, 5% 2012 to 2021 Medicare datasetMedicare 5% sample
- Participants
- 52,926 vs 94,795
- Exposure
- THA vs TKA
- THAn = 52,926
- TKAn = 94,795
- Outcome
- Variation in PNB utilization explained by socioeconomic, demographic, clinical and hospital variables (population-attributable risk (PARs), %)
Methodological detailsmixed-effects logistic regression, population-attributable risk framework
- Mixed-effects logistic regression
- Population-attributable risk framework
Main finding
As reported in the abstract
Proportion of variation in PNB use explained (PAR)
Clinical variables
Hospital variables
- Socioeconomic variables, up to
- 3%
- Demographic variables, up to
- 7%
- THA: PNB use, inpatient setting, OR
- 1.28 (95% CI 1.07-1.53)
- THA: PNB use, ≥2 prior hospitalizations, OR
- 0.72 (95% CI 0.57-0.90)
- THA: PNB use, nonosteoarthritis diagnoses, OR
- 0.64 (95% CI 0.58-0.72)
- TKA: PNB use, nonosteoarthritis diagnoses, OR
- 0.35 (95% CI 0.34-0.37)
Observational data: associations, not effects.
Secondary outcomes
| Outcome | OR (95% CI) | |
|---|---|---|
| CMS-defined complications, PNB use (TKA)PNB vs No PNB · TKA | 0.82 (0.75–0.90) | |
| LOS >3 days, PNB use (TKA)PNB vs No PNB · TKA | 0.90 (0.86–0.95) | |
| 90-day all-cause readmissions, PNB use (TKA) · 90 daysPNB vs No PNB · TKA; no association | 0.98 (0.93–1.03) | |
| 0.512Odds ratio (log scale) |
Secondary outcomes, PNB use (THA)
- In THA, associations did not reach statistical significance
Original publication
Socioeconomic, Patient, and Hospital Determinants for the Utilization of Peripheral Nerve Blocks in Total Joint Arthroplasty. Anesth Analg. Published 14 February 2025. doi:10.
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