Long-Term Outcomes Associated With Peripheral Nerve Blocks for Hip Fracture Surgery: A Retrospective Comparison of Medicare Data.

BACKGROUND

Peripheral nerve blocks (PNBs) are increasingly recommended as analgesia for hip fractures. Their association with outcomes beyond the immediate pharmacological effects remains unclear. This study examined the association between the use of PNBs and the number of days alive and at home after hip fracture surgery among Medicare beneficiaries.

METHODS

To examine the association between PNBs and long-term outcomes in older adults undergoing surgical fixation for hip fractures, we analyzed Medicare data from 2010 to 2018. Patients who received PNBs (exposure group) (n = 5701) were compared to those who did not receive a PNB (comparator group) using 1:1 propensity score matching, creating 5700 matched pairs. The primary outcome was days alive and at home within 120 days of admission. Secondary outcomes included days alive and at home within 365 days and 1-year mortality. A subgroup analysis of propensity score matched patients from 2018 examined outcomes when techniques had improved and use had increased.

RESULTS

In the primary analysis (2010-2018), no significant differences were observed between groups for days alive and at home within 120 days (68.1 vs. 68.4 days; p = 0.64), days alive and at home within 365 days (244.5 vs. 240.7 days; p = 0.12), or 1-year mortality (21% vs. 22%; p = 0.22). In 2017 and 2018, when peripheral nerve block use increased, patients who received PNBs spent more days alive and at home within 365 days than patients who did not receive peripheral nerve blocks (248.6 vs. 241.6 days; p = 0.04).

CONCLUSION

PNBs showed no association with improved outcomes across the 2010-2018 study period. Analysis of 2017 and 2018 revealed more days alive and at home within 365 days and a trend toward reduced mortality among patients who received PNBs. PNBs may provide benefits beyond their immediate analgesic effects, potentially improving long-term outcomes.