• Gavin M Hamilton, Manoj M Lalu, Reva Ramlogan, Gregory L Bryson, Faraj W Abdallah, McCartney Colin J L CJL, and Daniel I McIsaac.
• From The Ottawa Hospital (G.M.H., M.M.L., R.R., G.L.B., F.W.A., C.J.L.M., D.I.M.) the Departments of Anesthesiology and Pain Medicine (G.M.H., M.M.L., R.R., G.L.B., F.W.A., C.J.L.M., D.I.M.) the Department of Cellular and Molecular Medicine (M.M.L.) the School of Epidemiology and Public Health (D.I.M.), University of Ottawa, Ottawa, Ontario, Canada the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (M.M.L., R.R., G.L.B., F.W.A., C.J.L.M., D.I.M.) the Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada (D.I.M.).
• Anesthesiology. 2019 Nov 1; 131 (5): 1025-1035.

BackgroundAdverse outcomes and resource use rates are high after hip fracture surgery. Peripheral nerve blocks could improve outcomes through enhanced analgesia and decreased opioid related adverse events. We hypothesized that these benefits would translate into decreased resource use (length of stay [primary outcome] and costs), and better clinical outcomes (pneumonia and mortality).MethodsThe authors conducted a retrospective cohort study of hip fracture surgery patients in Ontario, Canada (2011 to 2015) using linked health administrative data. Multilevel regression, instrumental variable, and propensity scores were used to determine the association of nerve blocks with resource use and outcomes.ResultsThe authors identified 65,271 hip fracture surgery patients; 10,030 (15.4%) received a block. With a block, the median hospital stay was 7 (interquartile range, 4 to 13) days versus 8 (interquartile range, 5 to 14) days without. Following adjustment, nerve blocks were associated with a 0.6-day decrease in length of stay (95% CI, 0.5 to 0.8). This small difference was consistent with instrumental variable (1.1 days; 95% CI, 0.9 to 1.2) and propensity score (0.2 days; 95% CI, 0.2 to 0.3) analyses. Costs were lower with a nerve block (adjusted difference, -$1,421; 95% CI, -$1,579 to -$1,289 [Canadian dollars]), but no difference in mortality (adjusted odds ratio, 0.99; 95% CI, 0.89 to 1.11) or pneumonia (adjusted odds ratio, 1.01; 95% CI, 0.88 to 1.16) was observed.ConclusionsReceipt of nerve blocks for hip fracture surgery is associated with decreased length of stay and health system costs, although small effect sizes may not reflect clinical significance for length of stay.

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