Outcomes After Proximal Humerus Surgery: Does Regional Anesthesia Usage Matter?

Regional anesthesia is commonly used for intraoperative pain control during proximal humerus fracture surgery. We hypothesized that patients undergoing proximal humerus fracture surgery who received regional anesthesia would have increased postoperative emergency department (ED) utilization, increased perioperative opioid prescriptions, and greater incidence of persistent postoperative opioid prescriptions compared with those who received general anesthesia.

We retrospectively identified patients ≥18 years of age with a closed proximal humerus fracture undergoing either open reduction internal fixation (ORIF) or shoulder arthroplasty within 21 days of the fracture. We used International Classification of Diseases (ICD) 9/10 codes to identify patients using an administrative claims database. We categorized and then propensity-score matched patients based on receipt of regional anesthesia during surgery. Our first outcome was any instance of an ED visit within 7 and 30 days after surgery. Secondary outcomes included perioperative opioid prescriptions and the incidence of persistent opioid prescriptions. Multivariable regression models were used to assess the risk of an ED visit or persistent opioid usage based on the receipt of intraoperative regional anesthesia, adjusting for demographics and comorbidities.

In total, 10,580 (33.3%) ORIF patients and 3,299 (33.6%) shoulder arthroplasty patients received regional anesthesia during surgery. Regional anesthesia was associated with an increased 7-day ED visit incidence compared to no regional anesthesia receipt for ORIF patients (3.3% vs 2.3%) and shoulder arthroplasty patients (2.7% vs 1.9%) (P < .001 for both). In the 30-day postoperative window, regional anesthesia was associated with an increased incidence of an ED visit for ORIF patients (7.1% vs 5.8%) and shoulder arthroplasty patients (6.6% vs 5.2%) (P < .001 for both). Regional anesthesia was also associated with greater perioperative opioid prescriptions across both surgeries (P < .05).

Further research should explore interventions for proximal humerus fracture surgery patients who receive regional anesthesia to reduce potentially preventable ED visits and opioid-related adverse events.

Therapeutic III.