title: Regional Anesthesia Is Cost-Effective in Preventing Unanticipated Hospital Admission in Pediatric Patients Having Anterior Cruciate Ligament Reconstruction.
abstract: OBJECTIVE
  Published studies have shown a benefit of regional anesthesia (RA) in preventing unplanned hospital admissions (UHAs) and decreasing hospital costs after orthopedic surgeries in adults but not pediatric patients. We performed a retrospective analysis to assess the effect of converting from an opioid to RA-based approach to pain management after pediatric anterior cruciate ligament (ACL) reconstruction.
  
  
  METHODS
  The records of patients having ACL reconstruction were reviewed. Two groups, those with (n = 115) and without (n = 39) nerve blocks, were identified. Single-shot blocks or indwelling catheters were performed in the operating room (OR) or a block room. Time to discharge readiness, postoperative opiate and antiemetic consumption, hospital admission or discharge, and complications were recorded. The cost of providing RA, the change in UHA and postanesthesia care unit utilization, and subsequent financial impact were calculated.
  
  
  RESULTS
  Regional anesthesia-based pain management was associated with a lower rate of UHA (P = 0.045), less time in postanesthesia care unit phase II (P = 0.013), and a reduction in opioid consumption (P < 0.001). Use of a dedicated RA team with a dedicated block room resulted in cost savings or neutrality, whereas RA catheters placed in the OR were associated with increased direct hospital costs.
  
  
  CONCLUSIONS
  Regional anesthesia for pain after ACL repair in pediatric patients facilitated reliable same-day surgery discharge and significantly reduced UHAs. Single-shot blocks and blocks performed outside the OR were the most cost-effective. In addition, nerve block patients required less opioids and were ready for discharge sooner.
authors.affiliation: From the *Department of Anesthesiology, University of Pittsburgh School of Medicine; †Children's Hospital of Pittsburgh of UPMC; and ‡Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh; and §Lake Erie College of Osteopathic Medicine, Erie, PA; ∥George Washington University Milken Institute School of Public Health, Washington, DC; and **Department of Anesthesiology, Boston Children's Hospital, Boston, MA.
authors.forename: Denise Michelle
authors.initials: DM
authors.lastname: Hall-Burton
authors.forename: Mark E
authors.initials: ME
authors.lastname: Hudson
authors.forename: Jan S
authors.initials: JS
authors.lastname: Grudziak
authors.forename: Sarah
authors.initials: S
authors.lastname: Cunningham
authors.forename: Katherine
authors.initials: K
authors.lastname: Boretsky
authors.forename: Karen R
authors.initials: KR
authors.lastname: Boretsky
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000701:Analgesics, Opioid / Q000191:economics / Q000627:therapeutic use; D000762:Anesthesia Recovery Period; D000070598:Anterior Cruciate Ligament Injuries / Q000175:diagnosis / Q000191:economics* / Q000601:surgery*; D059549:Anterior Cruciate Ligament Reconstruction / Q000009:adverse effects / Q000191:economics*; D002648:Child; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D009407:Nerve Block / Q000009:adverse effects / Q000191:economics*; D009873:Operating Rooms / Q000191:economics; D010149:Postoperative Pain / Q000175:diagnosis / Q000191:economics* / Q000517:prevention & control*; D010351:Patient Discharge / Q000191:economics; D010359:Patient Readmission / Q000191:economics*; D020250:Postoperative Nausea and Vomiting / Q000191:economics / Q000209:etiology; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid