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      AQI 56: Use of Neuraxial Techniques and/or Peripheral Nerve Blocks for Total Knee Arthroplasty (TKA) ***RETIRED 2023***

      MEASURE DESCRIPTION:
      Percentage of patients, regardless of age, that undergo primary total knee arthroplasty for whom neuraxial anesthesia and/or a peripheral nerve block is performed.

      NQS DOMAIN/MEANINGFUL MEASURES AREA:
      Effective Clinical Care / Appropriate use of Healthcare

      MEASURE TYPE:
      Process

      HIGH PRIORITY STATUS:
      No

      INVERSE MEASURE:
      No

      RISK ADJUSTED:
      No

      INSTRUCTIONS:
      This measure is to be reported each time a patient undergoes primary total knee arthroplasty. It is anticipated that qualified anesthesia providers and eligible clinicians who provide denominator-eligible services will submit this measure.

      Measure Reporting via the Qualified Clinical Data Registry

      Patient demographics and CPT codes are used to identify patients who are included in the measure denominator. G-codes and Registry Codes are used to capture the numerator.

      DENOMINATOR: 
      All patients, regardless of age, who undergo primary total knee arthroplasty

      • Denominator Criteria (Eligible Cases):

        All patients, regardless of age

        AND

        Patient encounter during the reporting period (CPT):

        01402

      • Denominator Exclusions:

        Revision of TKA: CPT 27486, 27487 or 11A09

        OR

        Prosthesis Removal: CPT 27488 or 11A10

      NUMERATOR:

      Patients for whom neuraxial anesthesia and/or a peripheral nerve block is performed.

      Numerator Note: For the purposes of this measure, a peripheral nerve block performed either as primary procedural anesthesia or performed for postoperative analgesia would meet the numerator.

      • Numerator Options:

        Performance Met: Neuraxial anesthesia and/or a peripheral nerve block was used (10A78)

        OR

        Performance Not Met: Neuraxial anesthesia and/or a peripheral nerve block was NOT used (10A79)

        OR

        Denominator Exception: Documentation of patient reason(s) for not using either neuraxial anesthesia or a peripheral nerve block (e.g., patient refusal) (11A01)

        OR

        Denominator Exception: Surgeon administered nerve block (11A81)

      RELEVANT FIELDS:

      • ASA and Surgical CPT Code

      •  Neuraxial anesthesia provided

      RATIONALE:

      Regional anesthesia is associated with improved patient outcomes and lower postoperative morbidity and mortality compared to general anesthesia in patients undergoing TKA. Patients receiving neuraxial anesthesia typically lose less blood during surgery, leading to reduced need for many blood transfusions. Additionally, some studies support the notion that spinal anesthesia is associated with lower incidence of surgical site infection when compared to general anesthesia. Peripheral nerve blocks (PNBs) can be used as part of a pain management protocol after knee replacement surgery when compared with systemic analgesia, patients receiving PNBs have better pain scores and use less opioids after surgery. By requiring fewer opioids after surgery, patients also avoid opioid-related side effect such as sedation, respiratory depression, nausea, vomiting, and constipation. They also have better functional outcomes and have overall, a better perioperative experience.

      Strength of the evidence supporting neuraxial anesthesia and PNB is sometimes questioned as some of the supporting studies are retrospective in nature and mainly derived from analysis of administrative databases. However, evidence from randomized clinical trials either support better outcomes with regional anesthesia or show that there is no difference with the anesthesia technique.


      REPORTING CODES: