the literature, we wanted to confirm these results at our hospital, a 500 bed academic community hospital in Cleveland, Ohio. Methods: This is a retrospective review of 6 months of cardiac surgery patients in an academic community hospital in Cleveland, Ohio. 108 patients were included in the analysis; 29 received IV APAP, 79 received usual care and were included as control patients. Baseline characteristics collected included: sex, weight, and age. A chart review was completed and all doses of opioid administered on post-operative day (POD) 0-2 were converted to milligrams (mg) of morphine based on opioid equivalence and tallied. The total mg of opioid administered for each day POD 0-2, total overall mg POD 0-2, and total mg/kg were compared between groups. All pain scores were recorded from POD 0-2. Median pain scores for each day POD 0-2 were compared between groups. Number of antiemetic doses received and ICU length of stay was also compared. Results: Baseline characteristics did not differ between groups. Total mg of opioid received was significantly different on POD 0; 22.5 mg for the control group, 35 mg for the IV APAP group, p=0.007. Amount of opioid was not significantly different on POD 1-2, nor was the total mg or mg/kg amount different. Median pain scores on POD 0 were significantly lower in the control group group, 4 vs 6, p=0.002. However, ICU length of stay was shorter in the IV APAP group, even when adjusted for age and sex. No difference was noted in the number anti-emetic doses necessary in either group. When cardiac surgery other than coronary artery-bypass grafting was excluded (eg. mitral-valve replacement, etc.), the results were similar to the original analysis. Conclusions: Although previous studies have shown IV APAP to reduce the amount of opioid necessary as well as reduce pain scores after cardiac surgery, our study did not find the same result. On POD 0 patients in the IV APAP group had higher pain scores and required more opioid, but this effect did not continue on POD 1-2. Based on the relative expense of IV APAP compared with oral or rectal formulations, this data does not justify the drug's routine use for this patient population at our hospital. The IV APAP group did have a shorter ICU LOS but the data do not give an explanation as to why this is. Due to these results that conflict with other published literature, more studies are needed before IV APAP can be adopted as a standard of care in cardiac-surgery patients.
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