Postoperative Complications
Conditions
Keywords
Unplanned admissions, Visits to the ED, Readmissions, Death
Brief summary
This retrospective, population-based cohort study will evaluate the comparative effectiveness of peripheral nerve blocks on patient outcomes after ambulatory shoulder surgery in adults patients undergoing surgery in Ottawa, Ontario.
Detailed description
The investigators will use a coarsened exact matching algorithm prior to the analysis to minimize bias in this observational study. A multivariate logistic regression model will be used to compare the effect of anesthesia interventions on the primary outcome within matched cohorts. Sensitivity analyses will be used to evaluate the robustness of the primary analysis.
Interventions
Participants who receive a peripheral nerve block identified through the medical chart.
OTHERNo peripheral nerve blockade
Participants who did not receive a peripheral nerve block identified through the medical chart.
Sponsors
Ottawa Hospital Research Institute
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Ontario residents * Aged 18 years and older * Elective ambulatory shoulder surgery
Exclusion criteria
* Emergency Surgery
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative Complication | From day of surgery to 30 days after surgery | Composite outcome: 1) unplanned admissions on the day of surgery, 2) post-discharge ED visits within 30 days of surgery, 3) readmission within 30 days of surgery, and 4) death from any cause. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Health System Costs in the 30 Days After Surgery | From day of surgery to 30 days after surgery | Calculated using validated algorithms |
Countries
Canada
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Peripheral Nerve Block Peripheral nerve block
Peripheral nerve blockade: Participants who receive a peripheral nerve block identified through the medical chart. | 1,382 |
| No Peripheral Nerve Block No peripheral nerve block
No peripheral nerve blockade: Participants who did not receive a peripheral nerve block identified through the medical chart. | 241 |
| Total | 1,623 |
Baseline characteristics
| Characteristic | Peripheral Nerve Block | Total | No Peripheral Nerve Block |
|---|---|---|---|
| Age, Continuous | 50.1 years STANDARD_DEVIATION 15.4 | 49.7 years STANDARD_DEVIATION 15.4 | 47.1 years STANDARD_DEVIATION 15.4 |
| American Society of Anesthesiology (ASA) Score < 2 | 1054 Participants | 1237 Participants | 183 Participants |
| American Society of Anesthesiology (ASA) Score > 2 | 328 Participants | 380 Participants | 52 Participants |
| Campus Civic | 143 Participants | 167 Participants | 24 Participants |
| Campus General | 487 Participants | 616 Participants | 129 Participants |
| Campus Riverside | 752 Participants | 840 Participants | 88 Participants |
| Elixhauser comorbidity index 0 | 1380 Participants | 1620 Participants | 240 Participants |
| Elixhauser comorbidity index < 0 | 0 Participants | 0 Participants | 0 Participants |
| Elixhauser comorbidity index 1-5 | 0 Participants | 0 Participants | 0 Participants |
| Elixhauser comorbidity index > 5 | 0 Participants | 0 Participants | 0 Participants |
| Elixhauser comorbidity index Unable to report due to small cell size | 2 Participants | 3 Participants | 1 Participants |
| Sex: Female, Male Female | 455 Participants | 541 Participants | 86 Participants |
| Sex: Female, Male Male | 927 Participants | 1082 Participants | 155 Participants |
| Surgery Location Rotator cuff | 528 Participants | 573 Participants | 45 Participants |
| Surgery Location Shoulder joint | 852 Participants | 1040 Participants | 188 Participants |
| Surgery Location Shoulder muscle | 2 Participants | 10 Participants | 8 Participants |
| Surgery type Arthroscopic | 1297 Participants | 1509 Participants | 212 Participants |
| Surgery type Open | 85 Participants | 114 Participants | 29 Participants |
| Year of Surgery 2011/12 | 517 Participants | 648 Participants | 131 Participants |
| Year of Surgery 2013/14 | 422 Participants | 496 Participants | 74 Participants |
| Year of Surgery 2015/16 | 443 Participants | 479 Participants | 36 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 1,382 | 0 / 241 |
| other Total, other adverse events | 0 / 0 | 0 / 0 |
| serious Total, serious adverse events | 0 / 0 | 0 / 0 |
Outcome results
Primary
Postoperative Complication
Composite outcome: 1) unplanned admissions on the day of surgery, 2) post-discharge ED visits within 30 days of surgery, 3) readmission within 30 days of surgery, and 4) death from any cause.
Time frame: From day of surgery to 30 days after surgery
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Peripheral Nerve Block | Postoperative Complication | Composite outcome | 130 Participants |
| Peripheral Nerve Block | Postoperative Complication | Unplanned admission | 20 Participants |
| Peripheral Nerve Block | Postoperative Complication | Readmission within 30 days | 11 Participants |
| Peripheral Nerve Block | Postoperative Complication | ED visits within 30 days | 111 Participants |
| No Peripheral Nerve Block | Postoperative Complication | ED visits within 30 days | 11 Participants |
| No Peripheral Nerve Block | Postoperative Complication | Composite outcome | 23 Participants |
| No Peripheral Nerve Block | Postoperative Complication | Readmission within 30 days | 3 Participants |
| No Peripheral Nerve Block | Postoperative Complication | Unplanned admission | 12 Participants |
Secondary
Health System Costs in the 30 Days After Surgery
Calculated using validated algorithms
Time frame: From day of surgery to 30 days after surgery
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Peripheral Nerve Block | Health System Costs in the 30 Days After Surgery | 0 dollars |
| No Peripheral Nerve Block | Health System Costs in the 30 Days After Surgery | 0 dollars |