Is Regional Anesthesia More Cost-Efficient?

By now, nearly everyone knows how great peripheral nerve blocks (PNBs) are for patient care. But did you know that PNBs can also save surgical facilities money? A recent study of ours shows that facilities can save hundreds of thousands or even millions of dollars when they use PNBs as the anesthetic of choice.

The biggest savings come from a reduction in post-op complications. When compared to volatile anesthetics, PNBs cause fewer symptoms that require medications, labor-intensive PACU monitoring, and hospital admission. In our 1995-1999 study of 948 anterior cruciate ligament reconstruction patients, a full 88 percent of those who received PNBs (with or without adjunctive epidural or spinal anesthesia) bypassed PACU, and only 4 percent were admitted to the hospital. By comparison, just 9 percent of patients who received volatile general anesthesia bypassed PACU, and 20 percent were admitted (unplanned) to the hospital. Our PACU bypass results have been similar for rotator cuffs and other orthopedic procedures. For these reasons, we estimate that our hospital saves approximately $1.2 million annually when we use PNBs as our first choice for invasive orthopedic surgery patients, based on an estimate of 3,000 such patients per year.

Parameter

General Anesth.

PNB*

Mean Anesthesia-Controlled Time in the OR

20 minutes

11 minutes

PACU Bypass

9%

88%

Unplanned Hospital Admissions

20%

4%

*Some PNB patients also had adjunctive spinal or epidural anesthesia.
Source: Williams BA, Motolenich P, Kentor ML. Hospital Facilities and Resource Management: Economic Impact of a High-Volume Regional Anesthesia Program for Outpatients. Int Anesthesiol Clin. 2005 Summer;43(3):43-51.

But that's not all. PNBs also help eliminate variables that can prolong OR time—like anesthesia-induced blood pressure fluctuations, airway problems, and prolonged emergence from general anesthesia. PNBs also reduce the amount of OR time dedicated to anesthesia because they are administered in a block area. In our study of ACL patients, PNBs reduced anesthesia-controlled OR time in the OR by 45 percent.

Savings are institution-dependent, and vary depending on your particular set-up. Our facility, for example, has independently staffed phase I and II recovery units. We need further data to show how our cost savings will translate to facilities with integrated recovery units and cross-trained personnel.

Still, our assessment shows that the savings have potential to be especially significant in centers with high volumes. In these centers, PNBs can reduce nursing labor costs because they lessen nursing labor intensity and cut patient stays. In an eight-OR suite where surgeons are doing fairly uniform procedures at full capacity using routine PNB anesthesia, for example, we estimate employees could ‘close shop' a half-hour earlier each day—thereby avoiding forced overtime.

Importantly, PNBs set the stage for improving all of our processes. They have allowed us to meaningfully redefine our PACU, day-surgery unit discharge and hospital admission criteria. And when we look critically at our ‘tried and true' practices, we may find many other ways to improve efficiency.


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