Hospitalization Costs for Patients Undergoing Orthopedic Surgery Treated With Intravenous Acetaminophen (IV-APAP) Plus Other IV Analgesics or IV Opioid Monotherapy for Postoperative Pain

Abstract

IntroductionTo assess the impact on hospitalization costs of multimodal analgesia (MMA), including intravenous acetaminophen (IV-APAP), versus IV opioid monotherapy for postoperative pain management in patients undergoing orthopedic surgery.MethodsUtilizing the Truven Health MarketScan® Hospital Drug Database (HDD), patients undergoing total knee arthroplasty (TKA), total hip arthroplasty (THA), or surgical repair of hip fracture between 1/1/2011 and 8/31/2014 were separated into postoperative pain management groups: MMA with IV-APAP plus other IV analgesics (IV-APAP group) or an IV opioid monotherapy group. All patients could have received oral analgesics. Baseline characteristics and total hospitalization costs were compared. Additionally, an inverse probability treatment weighting [IPTW] with propensity scores analysis further assessed hospitalization cost differences.ResultsThe IV-APAP group (n = 33,954) and IV opioid monotherapy group (n = 110,300) differed significantly (P < 0.0001) across baseline characteristics, though the differences may not have been clinically meaningful. Total hospitalization costs (mean ± standard deviation) were significantly lower for the IV-APAP group than the IV opioid monotherapy group (US$12,540 ± $9564 vs. $13,242 ± $35,825; P < 0.0001). Medical costs accounted for $701 of the $702 between-group difference. Pharmacy costs were similar between groups. Results of the IPTW-adjusted analysis further supported the statistically significant cost difference.ConclusionsPatients undergoing orthopedic surgery who received MMA for postoperative pain management, including IV-APAP, had significantly lower total costs than patients who received IV opioid monotherapy. This difference was driven by medical costs; importantly, there was no difference in pharmacy costs. Generalizability of the results may be limited to patients admitted to hospitals similar to those included in HDD. Dosing could not be determined, so it was not possible to quantify utilization of IV-APAP or ascertain differences in opioid consumption between the 2 groups. This study did not account for healthcare utilization post-discharge.

Comparative analysis of length of stay, hospitalization costs, opioid use, and discharge status among spine surgery patients with postoperative pain management including intravenous versus oral acetaminophen

“…These findings also align with biological evidence of the potential interaction between morphine and oral APAP due to the inhibition of gastrointestinal motility by opioids, leading oral APAP to provide inadequate pain control in the surgical setting 15 . From the perspective of treatment protocol and medical policy development, this real world evidence is critical to help inform providers and hospital administrators about the benefits of IV APAP as part of multimodal analgesia 5,6,[16][17][18] . The body of literature regarding the use of IV APAP for postoperative pain consistently finds associations supporting the use of IV APAP to improve patient outcomes and reduce hospitalization costs 5,[16][17][18] .…”

Clinical Practice Guidelines for Pain Management in Acute Musculoskeletal Injury

“…In both cases, the use of multimodal therapy decreased hospital costs, directly related to medication, and overall hospital costs for patient stay. 190,191…”

Postoperative around-the-clock administration of intravenous acetaminophen for pain control following robot-assisted radical prostatectomy

“…IV acetaminophen, which inhibits prostaglandin synthesis, has been approved by the US FDA for management of mild to moderate pain, management of moderate to severe pain with opioid analgesics, and reduction of fever in adults and children over 2 years of age 20 . Opioids such as fentanyl, hydrocodone, morphine, and oxycodone have been used perioperatively to reduce postoperative pain and discomfort 21,22 . Receiving nonopioid therapy would be effective not only in the perioperative period but also in the long term after surgery.…”