The effect of continuous popliteal sciatic nerve block on unplanned postoperative visits and readmissions after foot surgery--a randomised, controlled study comparing day-care and inpatient management

Abstract

Regional anaesthesia has been shown to have several advantages over general anaesthesia in reducing the need for, and hence cost of, unscheduled outpatient visits or readmission to hospital. However, the benefit has not been evaluated in a direct comparison between day-care patients and inpatients. We randomly allocated 120 patients undergoing unilateral foot surgery to either inpatient (two-day postoperative stay) or day-care management under continuous regional anaesthesia, and compared the impact on unscheduled postoperative outpatient visits, readmissions to hospital and the associated costs. The operations were performed under popliteal sciatic nerve block. A perineural catheter was inserted before surgery and removed from all patients on the third postoperative day. We found no significant difference in the incidence of outpatient visits (3.3% day-care vs 5.0% inpatient, p = 0.640), readmissions (6.7% day-care vs 3.3% inpatient, p = 0.395) or complications between the two groups. Costs were also significantly lower in the day-care group (net difference €8011 (£6684; $10 986) per patient, p < 0.001). We conclude that continuous regional anaesthesia allows foot surgery to be performed as a day-care procedure more cheaply than in inpatients, without an increase in clinical complications.