Unanticipated costs associated with interscalene nerve catheters for shoulder surgery.

Autor: Jones PE; Steadman Hawkins Clinic of the Carolinas, Prisma Health-Upstate, Greenville, SC, USA., Kissenberth MJ; Steadman Hawkins Clinic of the Carolinas, Prisma Health-Upstate, Greenville, SC, USA., Brooks JM; Center for Effectiveness Research in Orthopaedics, Greenville, SC, USA., Thigpen CA; Center for Effectiveness Research in Orthopaedics, Greenville, SC, USA; ATI Physical Therapy, Greenville, SC, USA., Shanley E; Center for Effectiveness Research in Orthopaedics, Greenville, SC, USA; ATI Physical Therapy, Greenville, SC, USA., Pill SG; Steadman Hawkins Clinic of the Carolinas, Prisma Health-Upstate, Greenville, SC, USA. Electronic address: pillmd@gmail.com.
Jazyk: angličtina
Zdroj: Journal of shoulder and elbow surgery [J Shoulder Elbow Surg] 2023 Jun; Vol. 32 (6S), pp. S118-S122. Date of Electronic Publication: 2023 Feb 23.
DOI: 10.1016/j.jse.2023.02.010
Abstrakt: Background: Regional anesthesia has become a mainstay of analgesia following shoulder arthroscopic and reconstructive procedures. Local anesthetic can be injected in the perineural space of the brachial plexus by a single shot or continuously by an indwelling catheter. Although previous studies have compared efficacy and direct cost of single shot to catheters, few have evaluated unanticipated costs of ongoing care or complications. Pulmonary complications can lead to unexpected admissions and emergency department visits. The purpose of the study was to identify unplanned hospital admissions or emergency department visits related to regional anesthesia after shoulder surgery and determine the additional associated costs.
Methods: A series of 1888 shoulder surgeries were identified in 1856 unique patients at a single, large academic center. As part of an interscalene nerve catheter program, a continuous interscalene block (CIB) was given to 1728 patients, whereas 160 patients had a single-shot interscalene block (SSIB). A hospital-employed quality control nurse contacted all patients receiving a CIB at 1, 2, 7, and 14 days following surgery. All emergency department visits and readmissions were recorded, and the associated billing charges were reviewed for the inpatient and any outpatient visits immediately preceding or immediately following the readmission. The regional average Medicare fee schedule was used to determine a cost for these episodes of care.
Results: Of the 1728 patients who had CIB, 10 patients were readmitted following open or arthroscopic surgery or presented to the emergency department in the immediate postoperative period for pulmonary compromise. No patient in the SSIB group had an emergency department visit or readmission. The average age of the 10 patients with readmission was 60 years (7 females, 3 males). The majority were diagnosed with hypoxemia on admission (R09.02). Length of stay during readmission ranged from 0 to 4 days, with 1 patient requiring admission to the intensive care unit. The average cost of admission to the hospital or visit to the emergency department was $6849 (range, $1988-$19,483). These costs were primarily related to chest radiographs and electrocardiogram (9/10), chest computed tomography (CT) with contrast (3/10), and head CT (2/10).
Conclusion: Although uncommon, unanticipated pulmonary complications after CIB can result in significant cost compared to SSIB. The indirect costs of pulmonary workup after readmission or emergency department workup may be overlooked if only considering direct costs, such as medication charges, medical supplies, and physician fees.
(Copyright © 2023 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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