Emergency Department Visits and Opioid Utilization After Proximal Humerus Surgery: Does Regional Anesthesia Usage Matter?

Introduction: Regional and general anesthesia are commonly used for pain control in proximal humerus fracture surgery. This study explored the effects of regional anesthesia on postoperative emergency department (ED) visits and opioid usage in such surgeries.

Methods: Using an administrative claims database, we analyzed patients aged 18+ with closed proximal humerus fractures treated via open reduction internal fixation (ORIF) or shoulder arthroplasty. Exclusion criteria included open fractures and pre-existing opioid use disorder. Outcomes measured were ED visits within 7 and 30 days post-surgery, as well as perioperative and prolonged opioid usage, quantified in morphine milligram equivalents (MME). Multivariable regression models were used to assess the risk of an ED visit and prolonged opioid usage based on the usage of intraoperative regional anesthesia, adjusting for demographics.

Results: Regional anesthesia was associated with an increased 7- and 30-day ED visit risk for ORIF and shoulder arthroplasty patients (p<0.001) (Figure 1). Patients undergoing regional anesthesia for both procedures received greater mean total MMEs per day in the perioperative period compared to patients not receiving regional anesthesia (p<0.05). In the multivariable analysis, regional anesthesia was associated with a greater risk of prolonged opioid usage for ORIF patients (p<0.001). 

Conclusion: Regional anesthesia is a risk factor for greater 7- and 30-day unanticipated postoperative ED visitation and perioperative opioid utilization after both ORIF and shoulder arthroplasty surgery for closed proximal humerus fractures. Further research should explore interventions for patients undergoing proximal humerus surgery with regional anesthesia to reduce potentially preventable ED visits and opioid utilization.