title: Economics of nerve block pain management after anterior cruciate ligament reconstruction: potential hospital cost savings via associated postanesthesia care unit bypass and same-day discharge.
abstract: BACKGROUND
  Anterior cruciate ligament reconstruction is a complex outpatient surgical procedure often associated with pain. Traditionally, the procedure is performed under general anesthesia and often requires the use of the PACU. Refractory pain and/or nausea/vomiting occasionally leads to an unplanned hospital admission. In this study, the authors examine the associations of nerve block analgesia for these patients and its associated reductions in PACU use, hospital admission, and hospital costs.
  
  
  METHODS
  This was an observational, nonrandomized study in which existing data regarding patients' day-of-surgery outcomes were merged with hospital cost data. We reviewed a consecutive sample of 948 men and women who were in good health and underwent anterior cruciate ligament reconstruction in an outpatient surgery unit between July 1995 and June 1999.
  
  
  RESULTS
  The use of nerve block analgesia was associated with reduced PACU admissions to 18% and decreased unplanned hospital admission rates from 17% to 4%. Multivariate linear regression analysis showed that patients bypassing the PACU had an associated hospital cost reduction of 12% (P = 0.0001), whereas patients who needed hospital admission had an associated hospital cost increase of 11% (P = 0.0003).
  
  
  CONCLUSIONS
  The use of nerve blocks for acute pain management in patients undergoing anterior cruciate ligament reconstruction is associated with PACU bypass and reliable same-day discharge. Although the cost savings for this one procedure are unlikely to generate sufficient cost savings via staffing reductions, extrapolating these results to a large volume of all types of invasive outpatient orthopedic procedures may have the potential to create significant hospital cost savings.
authors.affiliation: Same-Day Surgical Services, University of Pittsburgh Medical Center, Pennsylvania 15203, USA. williamsba@anes.upmc.edu
authors.forename: Brian A
authors.initials: BA
authors.lastname: Williams
authors.forename: Michael L
authors.initials: ML
authors.lastname: Kentor
authors.forename: Molly T
authors.initials: MT
authors.lastname: Vogt
authors.forename: William B
authors.initials: WB
authors.lastname: Vogt
authors.forename: Kim C
authors.initials: KC
authors.lastname: Coley
authors.forename: John P
authors.initials: JP
authors.lastname: Williams
authors.forename: Mark S
authors.initials: MS
authors.lastname: Roberts
authors.forename: Jacques E
authors.initials: JE
authors.lastname: Chelly
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Harner
authors.forename: Freddie H
authors.initials: FH
authors.lastname: Fu
mesh_terms: D000328:Adult; D000556:Ambulatory Surgical Procedures / Q000191:economics*; D000700:Analgesics / Q000191:economics; D000777:Anesthetics / Q000191:economics; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000932:Antiemetics / Q000191:economics; D017046:Cost Savings; D005260:Female; D017721:Hospital Costs; D006801:Humans; D016014:Linear Models; D008297:Male; D009407:Nerve Block / Q000191:economics*; D010149:Postoperative Pain / Q000191:economics* / Q000628:therapy*; D020250:Postoperative Nausea and Vomiting / Q000188:drug therapy / Q000191:economics; D019651:Plastic Surgery Procedures / Q000191:economics*; D011997:Recovery Room / Q000191:economics*
chemical_list: D000700:Analgesics; D000777:Anesthetics; D000932:Antiemetics