Regional anesthesia for hysterectomies across a large healthcare system: location matters.

Abstract

Purpose: While guidelines emphasize the benefits of multimodal anesthesia for hysterectomy procedures, including regional anesthesia (RA), utilization rates remain understudied. This study described multilevel factors associated with RA receipt across the US Military Health System.

Methods: This retrospective cohort study included patients undergoing a hysterectomy between January 2022 and April 2025 (N = 5,150). Patient- (e.g., demographic and clinical information), care- (e.g., route, surgical duration, adjuncts), and system- (e.g., facility) level factors were covariates in a generalized additive mixed-effects model (GAMM) evaluating RA receipt.

Results: Overall, 13% received RA. Across 33 facilities, RA use ranged from 0 to 66% (median 9%, IQR 3-15%). In the GAMM, surgical facility accounted for 23% of the outcome variance. Odds (95% CI) of RA receipt were higher for patients with a Charlson Comorbidity Index of 1 relative to 0 (OR = 1.33, 1.03-1.71, p = 0.03), with leiomyoma diagnoses (OR = 1.26, 1.01-1.58, p = 0.04), and who received an open hysterectomy (OR = 6.02, 4.55-7.96, p < 0.001) and more adjuncts (OR = 1.15, 1.05-1.27, p = 0.005). The smooth effect of age was significant (p = 0.03), such increasing age was associated with lower odds of RA receipt.

Conclusion: RA receipt was not common; variability was largely attributed to facility. Patients receiving RA tended to receive more adjuncts (e.g., dexmedetomidine, ketamine, NSAID, acetaminophen, gabapentinoids), which suggests anesthesia clinicians who use RA are also those who more frequently use multimodal analgesia. Further research is needed to evaluate acute and subacute hysterectomy outcomes that accounts for the full range of anesthesia and analgesia selection, as well as clinician practice patterns and motivations for RA use.