NEWPORT BEACH, Calif. — The role of regional anesthesia has a positive impact on bundled payment programs, according to a speaker here.
“Regional anesthesia is a great way to address all these challenges: tackling pain in a non-opioid technique and getting patients up and moving,” Sonia Szlyk, MD, said at the Interdisciplinary Conference on Orthopedic Value-Based Care. “One of the reasons why regional is so impactful is because it allows us to be opioid sparing. Opioid-related adverse events are costly and common.”
A study published in Pain & Palliative Care Pharmacology showed 12.2% of 320,000 patients who underwent inpatient surgery for a total hip or total knee replacement had an opioid-related adverse event. Szlyk noted this added a significant cost to the system and was going to destroy the bundle because patients were hospitalized 3.3 days longer, there was a $4,707 average increase in hospital cost and there was a higher 30-day readmission rate.
“If you can do anything to reduce the patient’s need for opioids or reduce the risk of opioid-related adverse events, you are going to be more successful in a positive bundle payment scenario,” she said.
Regional anesthesia has been shown to decrease pain scores, postoperative nausea and vomiting, length of stay, post-anesthesia care unit time, use of opioids and opioid-related adverse events. In addition, regional anesthesia has also been linked with decreased emergency room and hospital readmission, and less need for acute rehabilitation and skilled nursing facilities. It has also been associated with increased patient and surgeon satisfaction, ambulation, physical therapy participation and discharge to home, Szlyk noted.
A study published in Anesthesiology that included more than 380,000 patients who underwent total hip or total knee replacement at 400 different hospitals showed neuraxial anesthesia lowered rates of 30-day mortality and in-hospital complications, and decreased length of stay and cost compared to general anesthesia.
According to a meta-analysis of 362,029 patients published in Regional Anesthesia and Pain Medicine, neuraxial anesthesia decreased the incidence of surgical site infections compared to general anesthesia.
“We need to do a serious reality check if we are focusing on value-based care. There is a significant importance on patient satisfaction, and pain management is at the heart of that. We have an ever-increasing and out-of-control opioid epidemic that we should all be focusing on,” Szlyk said. “This epidemic is just getting started. There are more than 70 million patients a year who are prescribed opioids for post-surgical pain.” – by Nhu Te, MS
Szlyk S. Regional anesthesia for CJR/multimodal premeds & chronic pain patients. Presented at: Interdisciplinary Conference on Orthopedic Value-Based Care; Jan. 20-22; Newport Beach, Calif.
Disclosure: Szlyk reports she is on the national speakers bureau for Halyard Health.