title: Factors associated with hospital admission after rotator cuff repair: the role of peripheral nerve blockade.
abstract: OBJECTIVE
  The objective was to analyze the impact of a peripheral nerve block in addition to general anesthesia on hospital admission after surgical rotator cuff repair.
  
  
  METHODS
  This was a population-based outcome study. The cost effectiveness of ambulatory rotator cuff repair relies on the discharge of patients on the day of surgery. As the impact of a peripheral nerve block in addition to general anesthesia on this outcome is unknown, we sought to elucidate this subject using population-based data.
  
  
  METHODS
  Information on patients undergoing rotator cuff surgery under general anesthesia with or without the addition of a peripheral nerve block (GN vs G) from a retrospective database provided by Premier Perspective, Inc, Charlotte, NC (http://www.premierinc.com), was analyzed. Using multilevel multivariable regressions, we evaluated the independent impact of the type of anesthesia on the outcomes hospital admission, combined major complications, and increased hospital costs.
  
  
  RESULTS
  We identified 27,201 patients who underwent surgical rotator cuff repair. Approximately 89% (24,240) of patients were discharged on the day of surgery, whereas 11% (2961) were admitted to the hospital. The admission rates for the GN group were 9.1% and 11.2% for the G group (P=.0001). The multivariable regression models showed that patients with the addition of a peripheral nerve block had 18% less risk of being admitted to the hospital (relative risk [RR]=0.82; 95% confidence interval [CI], 0.74-0.91; P=.0003) compared with those without this intervention. Differences in risk for combined major complications (RR=1.00; 95% CI, 0.83-1.20; P=.9751) or increased hospital costs (RR=0.97; 95% CI, 0.93-1.02; P=.2538) were nonsignificant.
  
  
  CONCLUSIONS
  For patients undergoing surgical rotator cuff repair under general anesthesia, the addition of a peripheral nerve block may be associated with a reduction in the need for postoperative hospital admission after ambulatory surgery. Although the reason for this finding has to remain speculative, better pain control may play a role.
authors: Department of Anesthesiology, Hospital for Special Surgery, Weill Cornell Medical College, New York, NY, USA; Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria.
authors: Thomas
authors: T
authors: Danninger
authors: Department of Anesthesiology, Hospital for Special Surgery, Weill Cornell Medical College, New York, NY, USA; Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria.
authors: Ottokar
authors: O
authors: Stundner
authors: Department of Health Policy and Research, Division of Biostatistics and Epidemiology, Weill Cornell Medical College, New York, NY, USA.
authors: Rehana
authors: R
authors: Rasul
authors: Department of Anesthesiology, Division of Pain Medicine, University of Michigan, Ann Arbor, MI, USA.
authors: Chad M
authors: CM
authors: Brummett
authors: Department of Health Policy and Research, Division of Biostatistics and Epidemiology, Weill Cornell Medical College, New York, NY, USA.
authors: Madhu
authors: M
authors: Mazumdar
authors: Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria.
authors: Peter
authors: P
authors: Gerner
authors: Department of Anesthesiology, Hospital for Special Surgery, Weill Cornell Medical College, New York, NY, USA; Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria. Electronic address: MemtsoudisS@hss.edu.
authors: Stavros G
authors: SG
authors: Memtsoudis
mesh_terms: D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures / Q000706:statistics & numerical data*; D000768:Anesthesia, General / Q000379:methods; D003362:Cost-Benefit Analysis; D016208:Databases, Factual; D005260:Female; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D012044:Regression Analysis; D012189:Retrospective Studies; D017006:Rotator Cuff / Q000601:surgery*
keywords: Cost effectiveness; Hospital admission; Peripheral nerve block; Regional anesthesia; Rotator cuff repair