From the Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania.
Anesth Analg. 2021 Jul 1;133(1):32-40. doi: 10.1213/ANE.0000000000005368.
Compared to general anesthesia, regional anesthesia confers several benefits including improved pain control and decreased postoperative opioid consumption. While the benefits of peripheral nerve blocks (PNB) have been well studied, there are little epidemiological data on PNB usage in mastectomy and lumpectomy procedures. The primary objective of our study was to assess national trends of the annual proportion of PNB use in breast surgery from 2010 to 2018. We also identified factors associated with PNB use for breast surgery.
We identified lumpectomy and mastectomy surgical cases with and without PNB between 2010 and 2018 using the Anesthesia Quality Institute National Anesthesia Clinical Outcomes Registry (AQI NACOR). We modeled the nonlinear association between year of procedure and PNB use with segmented mixed-effects logistic regression clustered on facility identifier. The association between PNB use and year of procedure, age, sex, American Society of Anesthesiologists physical status (ASA PS), facility type, facility region, weekday, and tissue expander use was also modeled using mixed-effects logistic regression.
Of the 189,854 surgical cases from 2010 to 2018 that met criteria, 86.2% were lumpectomy cases and 13.8% were mastectomy cases. The proportion of lumpectomy cases with PNB was <0.1% in 2010 and increased each subsequent year to 1.9% in 2018 (trend P < .0001). The proportion of mastectomy cases with PNB was 0.5% in 2010 and 13% in 2018 (trend P < .0001). The year 2014 was the breakpoint selected for segmented regression. Before 2014, the odds of PNB among the mastectomy cases was not significantly different from year to year. After 2014, the odds of PNB increased by 2.24-fold each year (95% confidence interval [CI], 2.00-2.49; P < .001); interaction test for pre-2014 versus post-2014 was P < .001. Similar trends were seen in the lumpectomy cases, where after 2014, the odds of PNB increased by 2.03-fold (95% CI, 1.81-2.27; P < .001); interaction test for pre-2014 versus post-2014 was P < .001. In the mastectomy cohort, year of procedure ≥2014, female sex, facility region, and tissue expander use were associated with higher odds of PNB. For lumpectomy cases, year of procedure ≥2014 and facility region were associated with higher odds of PNB use.
We found increased annual utilization of PNB for mastectomy and lumpectomy since 2010, although absolute prevalence is low. PNB use was associated with year of procedure for both lumpectomy and mastectomy, particularly post-2014.
与全身麻醉相比，区域麻醉具有许多优势，包括改善疼痛控制和减少术后阿片类药物的使用。虽然外周神经阻滞（PNB）的益处已经得到了很好的研究，但关于 PNB 在乳房切除术和肿块切除术中的使用的流行病学数据很少。我们研究的主要目的是评估 2010 年至 2018 年 PNB 在乳房手术中使用的年度比例的全国趋势。我们还确定了与 PNB 在乳房手术中的使用相关的因素。
我们使用麻醉质量协会国家麻醉临床结果登记处（AQI NACOR），确定了 2010 年至 2018 年间有和没有 PNB 的肿块切除术和乳房切除术手术病例。我们使用分段混合效应逻辑回归模型对年度手术和 PNB 使用之间的非线性关系进行建模，该模型在设施标识符上进行聚类。使用混合效应逻辑回归模型还对 PNB 使用与年度手术、年龄、性别、美国麻醉医师协会身体状况（ASA PS）、设施类型、设施区域、周内和组织扩张器使用之间的关系进行了建模。
在 2010 年至 2018 年符合标准的 189854 例手术中，86.2%为肿块切除术病例，13.8%为乳房切除术病例。2010 年，有 PNB 的肿块切除术病例比例<0.1%，随后每年增加，2018 年达到 1.9%（趋势 P<0.0001）。有 PNB 的乳房切除术病例比例在 2010 年为 0.5%，在 2018 年为 13%（趋势 P<0.0001）。2014 年是选择进行分段回归的转折点。在 2014 年之前，乳房切除术病例中 PNB 的几率与每年没有显著差异。2014 年之后，PNB 的几率每年增加 2.24 倍（95%置信区间，2.00-2.49；P<0.001）；2014 年前后的交互检验 P<0.001。在肿块切除术病例中也观察到类似的趋势，其中 2014 年之后，有 PNB 的几率增加了 2.03 倍（95%置信区间，1.81-2.27；P<0.001）；2014 年前后的交互检验 P<0.001。在乳房切除术队列中，手术年份≥2014 年、女性、设施区域和组织扩张器的使用与 PNB 更高的几率相关。对于肿块切除术病例，手术年份≥2014 年和设施区域与 PNB 使用的几率更高相关。
自 2010 年以来，我们发现乳房切除术和肿块切除术的 PNB 年度使用率有所增加，尽管绝对流行率较低。PNB 的使用与乳房切除术和肿块切除术的年度手术有关，尤其是 2014 年以后。
