Differences in Regional Anesthesia Utilization by Hospital Region in the United States

Area of Science:

• Anesthesiology
• Health Services Research
• Surgical Outcomes

Background:

• Regional anesthesia (RA) is linked to better postoperative outcomes.
• Existing research indicates disparities in RA utilization.
• No prior studies have investigated RA utilization based on hospital region.

Purpose of the Study:

• To analyze regional variations in the utilization of regional anesthesia (RA) across different surgical procedures.
• To identify specific geographic areas with higher or lower RA rates.
• To understand the impact of hospital region on RA adoption.

Main Methods:

• A national hospital database (HCA) was queried for adult patients undergoing specific surgical procedures between January 2016 and June 2021.
• Procedures included: total knee arthroplasty (TKA), total shoulder arthroplasty (TSA), anterior cruciate ligament reconstruction (ACLR), carpal tunnel release, total abdominal hysterectomy (TAH), ankle ORIF, and AV fistula creation.
• Regional anesthesia (RA) rates were calculated using summary statistics, and chi-squared analyses determined significant regional differences.

Main Results:

• Out of 52,068 patients, 4.1% received RA. Highest RA rates were observed for TSA (5.8%), TKA (4.5%), and ACLR (3.6%). TAH had the lowest RA rate (1.1%).
• The Midwest region demonstrated significantly higher RA utilization for TKA (10.9%), ACLR (8.1%), TAH (16.7%), and AV fistula creation (6.4%) compared to other regions.
• The West region showed the highest RA utilization for carpal tunnel release (11.8%) and ankle ORIF (7.8%). No significant regional differences were found for TSA.

Conclusions:

• Significant regional disparities exist in the utilization of regional anesthesia (RA) for various surgical procedures.
• The Midwest region leads in RA use for TKA, ACLR, TAH, and AV fistula creation.
• The West region demonstrates higher RA utilization for ankle ORIF and carpal tunnel release, highlighting geographic variations in anesthetic practice.