Differences in Regional Anesthesia Utilization by Hospital Region in the United States

Abstract

Abstract Background Regional anesthesia (RA) has demonstrated distinct advantages over general anesthesia, including decreased infection risk, lower rates of complications, and improved patient satisfaction. As such, the rate of RA utilization has been increasing, particularly among outpatient orthopedic surgeries like total hip arthroplasty and total knee arthroplasty. However, no studies have examined utilization rates as a function of hospital region. Methods A national hospital database (Hospital Corporation of American, HCA) was queried for patients 18 years or older that received selected surgical procedure codes between January 2016 and June 2021. The included CPT codes were for total knee arthroplasty (TKA), total shoulder arthroplasty (TSA), anterior cruciate ligament reconstruction (ACLR), carpal tunnel release, total abdominal hysterectomy (TAH), open reduction and internal fixation (ORIF) of the ankle, and arteriovenous (AV) fistula creation. Regional anesthesia was defined as any form of neuraxial and/or peripheral nerve blocks. Basic summary statistics were utilized to calculate the rates of RA, and chi-squared analysis were calculated to determine significant differences in the rate of RA utilization. Results A total of 52068 patients were included, of which 2114 (4.06%) received RA. With respect to RA utilization by procedure, the greatest RA rates were for TSA (5.8%), TKA (4.5), and ACLR (3.6%), whereas the lowest RA rate was for TAH (1.1%). For the TKA cohort, the Midwest has a significantly greater utilization rate than the South or West (10.9% vs. 4.8% or 3.1%, p < 0.001). The Midwest also have the highest utilization rate in the ACLR cohort (8.1%, p < 0.001), TAH cohort (16.7%, p < 0.001) and AV fistula cohort (6.4%, p < 0.001). For the carpal tunnel cohort, the West had the highest utilization rate (11.8% vs. 8.1%, 1.1%, 0%, p < 0.001). The West region also had the highest utilization rate for the ankle ORIF cohort (7.8%, p < 0.001). No significant differences were found by region for TSA (p = 0.312). Conclusion Significant variations in RA utilization rates were found by region, with the West having the highest utilization for ankle ORIF and carpal tunnel, and the Midwest having the highest rate for TKA, ACLR, TAH, and AV fistula.