David Ende1, Rodney A Gabriel1, Kamen V Vlassakov1, Richard P Dutton2, Richard D Urman3,4. 1. Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital/Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA. 2. US Anesthesia Partners, Dallas, TX, 75225, USA. 3. Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital/Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA. rurman@partners.org. 4. Department of Anesthesiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA. rurman@partners.org.
Abstract
BACKGROUND: Despite a growing body of literature illustrating the benefits of regional anaesthesia in shoulder arthroscopy, data on actual use of the technique in the United States is lacking. This study analyses epidemiologic data to describe current trends in anaesthetic practice for these procedures in the United States and highlights key associations with patient and provider demographic variables that may provide further insight. METHODS: We analysed the large database from the National Anesthesia Clinical Outcomes Registry of the Anesthesia Quality Institute. Of the 26,568,734 records available and after applying our exclusion criteria, we identified 169,878 shoulder arthroscopies performed from 2010 to 2014. The cases concerned all types of arthroscopic surgical procedures performed regardless of pathology (e.g. arthritis, instability, rotator cuff tears) These cases were sorted into three anaesthetic types consisting of general anaesthesia alone (GA, 62 %), general plus regional anaesthesia (GA+RA, 36 %) and RA alone (RA, 2 %). RESULTS: RA alone was more highly associated with board-certified anaesthesiologists practicing at university hospitals, older patients, patients with higher American Society of Anesthesiologists (ASA) classification and shorter procedures. RA is rarely used as the primary anaesthetic for these procedures across the country, while there is a steadily growing rate of GA+RA combination anaesthetics. CONCLUSIONS: Numerous advantages have been reported for utilizing RA and avoiding GA. The low rate at which RA is used as the sole anesthetic may represent room for improvement nationwide. GA+RA combination technique quickly became the predominant anaesthetic choice for shoulder arthroscopy during the five years of this analysis. LEVEL OF EVIDENCE: III.
BACKGROUND: Despite a growing body of literature illustrating the benefits of regional anaesthesia in shoulder arthroscopy, data on actual use of the technique in the United States is lacking. This study analyses epidemiologic data to describe current trends in anaesthetic practice for these procedures in the United States and highlights key associations with patient and provider demographic variables that may provide further insight. METHODS: We analysed the large database from the National Anesthesia Clinical Outcomes Registry of the Anesthesia Quality Institute. Of the 26,568,734 records available and after applying our exclusion criteria, we identified 169,878 shoulder arthroscopies performed from 2010 to 2014. The cases concerned all types of arthroscopic surgical procedures performed regardless of pathology (e.g. arthritis, instability, rotator cuff tears) These cases were sorted into three anaesthetic types consisting of general anaesthesia alone (GA, 62 %), general plus regional anaesthesia (GA+RA, 36 %) and RA alone (RA, 2 %). RESULTS:RA alone was more highly associated with board-certified anaesthesiologists practicing at university hospitals, older patients, patients with higher American Society of Anesthesiologists (ASA) classification and shorter procedures. RA is rarely used as the primary anaesthetic for these procedures across the country, while there is a steadily growing rate of GA+RA combination anaesthetics. CONCLUSIONS: Numerous advantages have been reported for utilizing RA and avoiding GA. The low rate at which RA is used as the sole anesthetic may represent room for improvement nationwide. GA+RA combination technique quickly became the predominant anaesthetic choice for shoulder arthroscopy during the five years of this analysis. LEVEL OF EVIDENCE: III.
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