Evidence map›Paper›PMID 36354132›Full record

Observational studyActa anaesthesiologica Scandinavica2023

Peripheral nerve-blocks and associations with length of stay and readmissions in fast-track total hip and knee arthroplasty.

Christoffer C Jørgensen, Pelle B Petersen, Louise O Daugberg, Thomas Jakobsen, Kirill Gromov, Claus Varnum, Mikkel R Andersen, Henrik Palm, Henrik Kehlet

Open access · hybridAbstract readObservational StudyMulticenter Study
In one paragraph

Observational study in Acta anaesthesiologica Scandinavica, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed
3.1field-weighted citation impact, top 8% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 14 citations in OpenAlex.

  1. Trial
  2. Article
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  4. Article
  5. Review
  6. Review
  7. Observational
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

9 authors at 7 institutions in 1 country.

Christoffer C JørgensenSection for Surgical Pathophysiology and the Center for Fast-Track Hip and Knee Replacement, Rigshospitalet Copenhagen University, Copenhagen, Denmark.ORCID https://orcid.org/0000-0001-6902-8181
Pelle B PetersenSection for Surgical Pathophysiology and the Center for Fast-Track Hip and Knee Replacement, Rigshospitalet Copenhagen University, Copenhagen, Denmark.
Louise O DaugbergDepartment of Orthopedics, Holstebro Hospital, Center for Fast-Track Hip and Knee Replacement, Copenhagen, Denmark.
Thomas JakobsenDepartment of Orthopedics, Interdisciplinary Orthopedics and the Center for Fast-Track Hip and Knee Replacement, Aalborg University Hospital, Copenhagen, Denmark.
Kirill GromovDepartment of Orthopedics and the Center for Fast-Track Hip and Knee Replacement, Hvidovre University Hospital, Copenhagen, Denmark.
Claus VarnumDepartment of Orthopedics and the Center for Fast-Track Hip and Knee Replacement, Lillebaelt Hospital - Vejle, Copenhagen, Denmark.
Mikkel R AndersenDepartment of Orthopedics and the Center for Fast-Track Hip and Knee Replacement, Gentofte Hospital, Copenhagen, Denmark.
Henrik PalmDepartment of Orthopedics and the Center for Fast-Track Hip and Knee Replacement, Bispebjerg Hospital, Copenhagen, Denmark.
Henrik KehletSection for Surgical Pathophysiology and the Center for Fast-Track Hip and Knee Replacement, Rigshospitalet Copenhagen University, Copenhagen, Denmark.ORCID https://orcid.org/0000-0002-2209-1711
University of Copenhagen · DKAalborg University Hospital · DKBispebjerg Hospital · DKGentofte Hospital · DKHvidovre Hospital · DKLillebaelt Hospital · DKRegional Hospital Holstebro · DK

Funding

Candys Foundation
6 · The paper itself

Abstract

backgroundPeripheral nerve blocks (PNB) have recently been recommended in total hip (THA) and knee (TKA) arthroplasty as they may reduce pain, morphine consumption, length of stay (LOS) and complications. However, whether PNBs are associated with early discharge within an enhanced recovery protocol including multimodal analgesia is uncertain.

methodsAn observational multicenter study from January to August 2017 in six Danish Arthroplasty Centers with established fast-track protocols. Prospective recording of preoperative characteristics and information on PNB, LOS and readmissions through the Danish National Patient Registry and medical records. Multiple logistic regression was used to investigate associations between PNB and a LOS >1 day, LOS >4 days, and 30-days readmissions. We also reported on mobilization, pain, opioid and fall-related complications leading to LOS >4 days or readmissions.

resultsA total of 2027 (58.6%) THA and 1432 (41.4%) TKAs with a median LOS of 1 day (IQR 1-2) and 5.3% (CI:4.6-6.1) 30-days readmission rate were identified. PNB was used in 40.7% (CI:38.2-43.3) of TKA and 2.7% (CI:2.0-3.5) of THA, but with considerable interdepartmental variation (0.0-89.0% for TKA). There was no association between PNB and LOS >1 day (OR:1.19 CI:0.82-1.72; p = .354), LOS >4 days (OR:1.4 CI:0.68-2.89; p = .359) or 30-days readmissions (OR:1.02 CI:0.63-1.65; p = .935) in TKA. Logistic regression in THA was not possible due to limited use of PNB. In TKA there were 12 (2.1% CI:1.2-3.6) with and 1 (0.1% CI:0.02-0.7) without a PNB, who had mobilization, pain or opioid-related complications, and 5 (0.9% CI:0.4-2.0) versus 4 (0.5% CI:0.2-1.2) who fell. Correspondingly, 2 (3.7% CI:1.0-12.6) and 11 (0.6% CI:0.3-1.0) of THA patients had these complications, while 0 (0.0% CI:0.0-6.6) and 17 (0.8% CI:0.5-1.3) fell.

conclusionRoutine use of peripheral nerve blocks was not associated with early discharge or 30-days readmissions in fast-track THA and TKA. Future studies should focus on benefits of PNB in high-risk patients.

Indexed as

Arthroplasty, Replacement, HipArthroplasty, Replacement, KneeAnalgesics, OpioidHumansLength of StayPatient ReadmissionPostoperative ComplicationsProspective StudiesAnalgesics, Opioidarthroplastyenhanced recoveryERASfast-track surgeryhipjoint replacementkneenerve blockorthopedicsregional anaesthesia

Identifiers

PMID36354132
PMCPMC10098538
OpenAlexW4308681250

What OpenQuestion holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.