Hospital Charges and Practice Patterns for General and Regional Anesthesia in Arthroscopic Anterior Cruciate Ligament Repair

Overview

Journal Orthop J Sports Med

Specialty Orthopedics

Date 2015 Nov 5

PMID 26535248

Citations 4

Authors

Brock D Foster

Rodney Terrell

Scott R Montgomery

Jeffrey C Wang

Frank A Petrigliano

David R McAllister

Affiliations

Soon will be listed here.

Abstract

Background: Anesthetic use for arthroscopic anterior cruciate ligament (ACL) reconstruction may display variability in hospital charges and utilization in the United States.

Purpose: To evaluate practice patterns and hospital charges for anesthesia in arthroscopic ACL reconstruction.

Study Type: Cross-sectional study.

Methods: The PearlDiver Patient Records Database, a national database of insurance billing records, was searched using the current procedural terminology (CPT) codes for arthroscopic ACL reconstruction in combination with different types of anesthesia. The search included the years between 2004 and 2009. Age, sex, number of procedures performed, geographic region, and hospital charges for each type of anesthesia were recorded and compared. Anesthetic types were categorized as general anesthesia (GA) only, GA with concomitant single femoral injection, GA with concomitant other regional anesthesia (RA), single femoral injection only, or other RA only.

Results: Between 2004 and 2009, a total of 53,968 arthroscopic reconstructive procedures were identified. The mean per patient hospital charge for GA alone, GA in combination with single femoral injection, GA in combination with other RA, single femoral injection alone, and RA alone was $1065 (63% of cases), $1614 (29%), $1849 (4%), $630 (3%), and $612 (1%), respectively. The use of GA in combination with RA or single femoral nerve injection significantly increased during this time period (P = .004 and P < .001, respectively).

Conclusion: The mean per patient hospital charges for arthroscopic ACL reconstruction varied with the mode of anesthesia utilized, where regional anesthetic techniques alone were least expensive. RA alone was utilized infrequently, and there was a significant increase in the rate of utilization of GA in combination with any form of RA.

Clinical Relevance: This study provides information on current trends and hospital charges for anesthesia in arthroscopic ACL reconstruction.

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References

Bonicalzi V, Gallino M . Comparison of two regional anesthetic techniques for knee arthroscopy. Arthroscopy. 1995; 11(2):207-12. DOI: 10.1016/0749-8063(95)90068-3. View

Forssblad M, Jacobson E, Weidenhielm L . Knee arthroscopy with different anesthesia methods: a comparison of efficacy and cost. Knee Surg Sports Traumatol Arthrosc. 2004; 12(5):344-9. DOI: 10.1007/s00167-004-0523-7. View

Iskandar H, Benard A, Ruel-Raymond J, Cochard G, Manaud B . Femoral block provides superior analgesia compared with intra-articular ropivacaine after anterior cruciate ligament reconstruction. Reg Anesth Pain Med. 2003; 28(1):29-32. DOI: 10.1053/rapm.2003.50019. View

Peng P, Claxton A, Chung F, Chan V, Miniaci A, Krishnathas A . Femoral nerve block and ketorolac in patients undergoing anterior cruciate ligament reconstruction. Can J Anaesth. 1999; 46(10):919-24. DOI: 10.1007/BF03013124. View

Auroy Y, Benhamou D, Bargues L, Ecoffey C, Falissard B, Mercier F . Major complications of regional anesthesia in France: The SOS Regional Anesthesia Hotline Service. Anesthesiology. 2002; 97(5):1274-80. DOI: 10.1097/00000542-200211000-00034. View

Oldman M, McCartney C, Leung A, Rawson R, Perlas A, Gadsden J . A survey of orthopedic surgeons' attitudes and knowledge regarding regional anesthesia. Anesth Analg. 2004; 98(5):1486-90, table of contents. DOI: 10.1213/01.ane.0000113549.98873.b1. View

Tierney E, Lewis G, Hurtig J, Johnson D . Femoral nerve block with bupivacaine 0.25 per cent for postoperative analgesia after open knee surgery. Can J Anaesth. 1987; 34(5):455-8. DOI: 10.1007/BF03014348. View

Mall N, Wright R . Femoral nerve block use in anterior cruciate ligament reconstruction surgery. Arthroscopy. 2010; 26(3):404-16. DOI: 10.1016/j.arthro.2009.08.014. View

OLeary , Unwin , Smith , Allum . The '3 in 1' lumbar plexus block following anterior cruciate ligament reconstruction with autologous hamstring tendons. Knee. 2000; 7(2):95-99. DOI: 10.1016/s0968-0160(00)00033-8. View

10.

Brull R, McCartney C, Chan V, El-Beheiry H . Neurological complications after regional anesthesia: contemporary estimates of risk. Anesth Analg. 2007; 104(4):965-74. DOI: 10.1213/01.ane.0000258740.17193.ec. View

11.

Frost S, Grossfeld S, Kirkley A, Litchfield B, Fowler P, Amendola A . The efficacy of femoral nerve block in pain reduction for outpatient hamstring anterior cruciate ligament reconstruction: a double-blind, prospective, randomized trial. Arthroscopy. 2000; 16(3):243-8. DOI: 10.1016/s0749-8063(00)90047-1. View

12.

Edkin B, Spindler K, Flanagan J . Femoral nerve block as an alternative to parenteral narcotics for pain control after anterior cruciate ligament reconstruction. Arthroscopy. 1995; 11(4):404-9. DOI: 10.1016/0749-8063(95)90191-4. View

13.

Matava M, Prickett W, Khodamoradi S, Abe S, Garbutt J . Femoral nerve blockade as a preemptive anesthetic in patients undergoing anterior cruciate ligament reconstruction: a prospective, randomized, double-blinded, placebo-controlled study. Am J Sports Med. 2008; 37(1):78-86. DOI: 10.1177/0363546508324311. View

14.

Shapiro M, Safran M, Crockett H, Finerman G . Local anesthesia for knee arthroscopy. Efficacy and cost benefits. Am J Sports Med. 1995; 23(1):50-3. DOI: 10.1177/036354659502300108. View

15.

Greenberg C . Practical, cost-effective regional anesthesia for ambulatory surgery. J Clin Anesth. 1995; 7(7):614-21. DOI: 10.1016/0952-8180(95)00134-4. View

16.

Daffner S, Beimesch C, Wang J . Geographic and demographic variability of cost and surgical treatment of idiopathic scoliosis. Spine (Phila Pa 1976). 2010; 35(11):1165-9. DOI: 10.1097/BRS.0b013e3181d88e78. View

17.

Kroll D, Caplan R, Posner K, Ward R, Cheney F . Nerve injury associated with anesthesia. Anesthesiology. 1990; 73(2):202-7. DOI: 10.1097/00000542-199008000-00002. View

18.

Masursky D, Dexter F, McCartney C, Isaacson S, Nussmeier N . Predicting orthopedic surgeons' preferences for peripheral nerve blocks for their patients. Anesth Analg. 2008; 106(2):561-7, table of contents. DOI: 10.1213/ane.0b013e3181607071. View