Search

OBJECTIVES: Although peripheral nerve blocks are associated with improved pain control and end outcomes among older adults with hip fracture, their current utilization among US hip fracture patients is not well understood. We characterized contemporary use of peripheral nerve blocks after hip fracture over time and identified predictors of nerve block receipt. DESIGN: Retrospective cohort study of claims data from one large national private US insurer. SETTING: US acute care hospitals. PARTICIPANTS: A total of 94 985 adults aged 50 years and older hospitalized for a femoral neck, intertrochanteric, or subtrochanteric fracture; 409 263 adults aged 50 years and older hospitalized for elective hip or knee arthroplasty between 2004 and 2016. MEASUREMENTS: Receipt of a peripheral nerve block for pain control, based on Current Procedural Terminology codes in physician service claims. RESULTS: Overall, 2874 hip fracture patients (3.0%; 95% confidence interval [CI] = 2.9‐3.1) received a nerve block for pain control, and the percentage receiving a block increased from.4% in 2004‐2006 (95% CI =.3%‐.6%) to 4.6% in 2013‐2016 (95% CI = 4.4%‐4.8%; P <.001). The adjusted odds of receiving a nerve block was lower for patients with vs without dementia (odds ratio [OR] =.88; 95% CI =.80‐.98; P =.02) and among patients aged 75 to 84 vs 64 years or younger (OR =.86; 95% CI =.74‐1.00; P =.02). The odds of nerve block receipt did not vary according to race, ethnicity, fracture location, or most other common comorbidities. Compared with patients with hip fracture, the adjusted odds of nerve block receipt were 2 times higher among patients undergoing elective hip replacement and more than 30 times higher among patients undergoing elective knee replacement. CONCLUSION: Although use of peripheral nerve blocks for pain control after hip fracture has increased over time, fewer than 5 of every 100 patients hospitalized with hip fracture currently receive a peripheral nerve block, suggesting possible underuse. J Am Geriatr Soc 68:835–840, 2020 See related Editorial by Ellen F. Binder [ABSTRACT FROM AUTHOR]

Objectives To determine hospital-level predictors of readmission after hip fracture or potentially related inpatient care processes. Design Retrospective cohort study. Setting U.S. acute care hospitals. Participants Fee-for-service Medicare beneficiaries who underwent hip fracture surgery between 2007 and 2009 (N = 458,526). Measurements Information was obtained on hospital case volumes, teaching status, bed count, nurse staffing, and technological capabilities from Medicare files, and multivariable logistic regression was used to measure the association between these factors and an endpoint of readmission or death at 30 days and between these factors and the timing of surgery. Results Participants treated in the highest-volume hospitals (>175 cases for the study period) had lower odds of readmission or death at 30 days than those treated in low-volume hospitals (≤12; adjusted odds ratio ( aOR) = 0.87, 95% confidence interval ( CI) = 0.83-0.92, P < .001). Higher nurse skill mix ( aOR = 0.88, 95% CI = 0.8-0.96; P = .007) and higher ratio of nurses to beds ( aOR = 0.98; 95% CI = 0.97-0.99; P < .001) were also associated with better 30-day outcomes. Greater hospital case volume was associated with lower odds of surgical delay beyond 48 hours. Conclusion Better nurse staffing and higher case volumes are associated with lower rates of readmission and mortality after hip fracture surgery; individuals treated at high-volume centers experienced fewer delays in treatment, potentially indicating better inpatient care processes. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented discussing a study comparing spinal and general anesthesia for hip fracture surgery.