scholarly journals A Population-based Comparative Effectiveness Study of Peripheral Nerve Blocks for Hip Fracture Surgery: Erratum

2019 ◽  
Vol 131 (6) ◽  
pp. 1373-1373
Keyword(s):  
Hip Fracture ◽  
Peripheral Nerve ◽  
Comparative Effectiveness ◽  
Population Based ◽  
Effectiveness Study ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks ◽  
Hip Fracture Surgery ◽  
Comparative Effectiveness Study ◽  
Fracture Surgery

scholarly journals A Population-based Comparative Effectiveness Study of Peripheral Nerve Blocks for Hip Fracture Surgery

2019 ◽  
Vol 131 (5) ◽  
pp. 1025-1035 ◽  
Author(s):  
Gavin M. Hamilton ◽  
Manoj M. Lalu ◽  
Reva Ramlogan ◽  
Gregory L. Bryson ◽  
Faraj W. Abdallah ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Length Of Stay ◽  
Resource Use ◽  
Odds Ratio ◽  
Instrumental Variable ◽  
Adjusted Odds Ratio ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks ◽  
Hip Fracture Surgery ◽  
Fracture Surgery

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Adverse outcomes and resource use rates are high after hip fracture surgery. Peripheral nerve blocks could improve outcomes through enhanced analgesia and decreased opioid related adverse events. We hypothesized that these benefits would translate into decreased resource use (length of stay [primary outcome] and costs), and better clinical outcomes (pneumonia and mortality). Methods The authors conducted a retrospective cohort study of hip fracture surgery patients in Ontario, Canada (2011 to 2015) using linked health administrative data. Multilevel regression, instrumental variable, and propensity scores were used to determine the association of nerve blocks with resource use and outcomes. Results The authors identified 65,271 hip fracture surgery patients; 10,030 (15.4%) received a block. With a block, the median hospital stay was 7 (interquartile range, 4 to 13) days versus 8 (interquartile range, 5 to 14) days without. Following adjustment, nerve blocks were associated with a 0.6-day decrease in length of stay (95% CI, 0.5 to 0.8). This small difference was consistent with instrumental variable (1.1 days; 95% CI, 0.9 to 1.2) and propensity score (0.2 days; 95% CI, 0.2 to 0.3) analyses. Costs were lower with a nerve block (adjusted difference, −$1,421; 95% CI, −$1,579 to −$1,289 [Canadian dollars]), but no difference in mortality (adjusted odds ratio, 0.99; 95% CI, 0.89 to 1.11) or pneumonia (adjusted odds ratio, 1.01; 95% CI, 0.88 to 1.16) was observed. Conclusions Receipt of nerve blocks for hip fracture surgery is associated with decreased length of stay and health system costs, although small effect sizes may not reflect clinical significance for length of stay.

scholarly journals Peripheral Nerve Blocks and Potentially Attributable Adverse Events in Older People with Hip Fracture: A Retrospective Population-based Cohort Study

2021 ◽  
Author(s):  
Natalie Melton ◽  
Robert Talarico ◽  
Faraj Abdallah ◽  
Paul E. Beaulé ◽  
Sylvain Boet ◽  
...  
Keyword(s):  
Patient Safety ◽  
Cohort Study ◽  
Hip Fracture ◽  
Adverse Events ◽  
Peripheral Nerve ◽  
Administrative Data ◽  
Nerve Block ◽  
Population Based ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks

Background Peripheral nerve blocks are being used with increasing frequency for management of hip fracture–related pain. Despite converging evidence that nerve blocks may be beneficial, safety data are lacking. This study hypothesized that peripheral nerve block receipt would not be associated with adverse events potentially attributable to nerve blocks, as well as overall patient safety incidents while in hospital. Methods This was a preregistered, retrospective population-based cohort study using linked administrative data. This study identified all hip fracture admissions in people 50 yr of age or older and identified all nerve blocks (although we were unable to ascertain the specific anatomic location or type of block), potentially attributable adverse events (composite of seizures, fall- related injuries, cardiac arrest, nerve injury), and any patient safety events using validated codes. The study also estimated the unadjusted and adjusted association of nerve blocks with adverse events; adjusted absolute risk differences were also calculated. Results In total, 91,563 hip fracture patients from 2009 to 2017 were identified; 15,631 (17.1%) received a nerve block, and 5,321 (5.8%; 95% CI, 5.7 to 6.0%) patients experienced a potentially nerve block–attributable adverse event: 866 (5.5%) in patients with a block and 4,455 (5.9%) without a block. Before and after adjustment, nerve blocks were not associated with potentially attributable adverse events (adjusted odds ratio, 1.05; 95% CI, 0.97 to 1.15; and adjusted risk difference, 0.3%, 95% CI, –0.1 to 0.8). Conclusions The data suggest that nerve blocks in hip fracture patients are not associated with higher rates of potentially nerve block–attributable adverse events, although these findings may be influenced by limitations in routinely collected administrative data. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

scholarly journals The association between initial opioid type and long-term opioid use after hip fracture surgery in elderly opioid-naïve patients

2020 ◽  
Vol 20 (4) ◽  
pp. 755-764
Author(s):  
Amalie H. Simoni ◽  
Lone Nikolajsen ◽  
Anne E. Olesen ◽  
Christian F. Christiansen ◽  
Søren P. Johnsen ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Pain Treatment ◽  
Population Based ◽  
Opioid Use ◽  
Calendar Time ◽  
Opioid Prescription ◽  
Hip Fracture Surgery ◽  
Opioid Users ◽  
Fracture Surgery

AbstractObjectivesLong-term opioid use after hip fracture surgery has been demonstrated in previously opioid-naïve elderly patients. It is unknown if the opioid type redeemed after hip surgery is associated with long-term opioid use. The aim of this study was to examine the association between the opioid type redeemed within the first three months after hip fracture surgery and opioid use 3–12 months after the surgery.MethodsA nationwide population-based cohort study was conducted using data from Danish health registries (2005–2015). Previously opioid-naïve patients registered in the Danish Multidisciplinary Hip Fracture Registry, aged ≥65 years, who redeemed ≥1 opioid prescription within three months after the surgery, were included. Long-term opioid use was defined as ≥1 redeemed prescription within each of three three-month periods within the year after hip fracture surgery. The proportion with long-term opioid use after surgery, conditioned on nine-month survival, was calculated according to opioid types within three months after surgery. Adjusted odds ratios (aOR) for different opioid types were computed by logistic regression analyses with 95% confidence intervals (CI) using morphine as reference. Subgroup analyses were performed according to age, comorbidity and calendar time before and after 2010.ResultsThe study included 26,790 elderly, opioid-naïve patients with opioid use within three months after hip fracture surgery. Of these patients, 21% died within nine months after the surgery. Among the 21,255 patients alive nine months after surgery, 15% became long-term opioid users. Certain opioid types used within the first three months after surgery were associated with long-term opioid use compared to morphine (9%), including oxycodone (14%, aOR; 1.76, 95% CI 1.52–2.03), fentanyl (29%, aOR; 4.37, 95% CI 3.12–6.12), codeine (13%, aOR; 1.55, 95% CI 1.14–2.09), tramadol (13%, aOR; 1.56, 95% CI 1.35–1.80), buprenorphine (33%, aOR; 5.37, 95% CI 4.14–6.94), and >1 opioid type (27%, aOR; 3.83, 95% CI 3.31–4.44). The proportion of long-term opioid users decreased from 18% before 2010 to 13% after 2010.ConclusionsThe findings suggest that use of certain opioid types after hip fracture surgery is more associated with long-term opioid use than morphine and the proportion initiating long-term opioid use decreased after 2010. The findings suggest that some elderly, opioid-naïve patients appear to be presented with untreated pain conditions when seen in the hospital for a hip fracture surgery. Decisions regarding the opioid type prescribed after hospitalization for hip fracture surgery may be linked to different indication for pain treatment, emphasizing the likelihood of careful and conscientious opioid prescribing behavior.

scholarly journals One-Year Readmission Risk and Mortality after Hip Fracture Surgery: A National Population-Based Study in Taiwan

2017 ◽  
Vol 8 (4) ◽  
pp. 402 ◽  
Author(s):  
Tien-Ching Lee ◽  
Pei-Shan Ho ◽  
Hui-Tzu Lin ◽  
Mei-Ling Ho ◽  
Hsuan-Ti Huang ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Population Based ◽  
Population Based Study ◽  
National Population ◽  
Hip Fracture Surgery ◽  
One Year ◽  
Fracture Surgery ◽  
Readmission Risk

scholarly journals Nuts and Bolts of Peripheral Nerve Blocks for Pain After Hip Fracture for Everyday Anesthetist

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Amjad Maniar ◽  
Joselo Macachor ◽  
Wan-Ling Alyssa Chiew ◽  
Chandra M. Kumar ◽  
Farnad Imani ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Peripheral Nerve ◽  
Informed Decision ◽  
Technical Approach ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks ◽  
Single Block

: A range of peripheral nerve blocks is available to treat hip fracture pain, leaving clinicians confused on choice. No single block appears to be outstanding. The study described the relevant anatomy, technical approach, risk associated, and practicability to facilitate a better understanding of the various approaches available. The clinician should be able to make an informed decision based on local requirements and logistics.

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