Estimating the Effect of Intravenous Acetaminophen for Postoperative Pain Management on Length of Stay and Inpatient Hospital Costs

Abstract

IntroductionThe provision of safe, effective, cost-efficient perioperative inpatient acute pain management is an important concern among clinicians and administrators within healthcare institutions. Overreliance on opioid monotherapy in this setting continues to present health risks for patients and increase healthcare costs resulting from preventable adverse events. The goal of this study was to model length of stay (LOS), potential opioid-related complications, and costs for patients reducing opioid use and adding intravenous acetaminophen (IV APAP) for management of postoperative pain.MethodsData for this study were de-identified inpatient encounters from The Advisory Board Company across 297 hospitals from 2012–2014, containing 2,238,433 encounters (IV APAP used in 12.1%). Encounters for adults ≥18 years of age admitted for cardiovascular, colorectal, general, obstetrics and gynecology, orthopedics, or spine surgery were included. The effects of reducing opioids and adding IV APAP were estimated using hierarchical statistical models. Costs were estimated by multiplying modeled reductions in LOS or complication rates by observed average volumes for medium-sized facilities, and by average cost per day or per complication (LOS: US$2383/day; complications: derived from observed charges).ResultsAcross all surgery types, LOS showed an average reduction of 18.5% (10.7–32.0%) for the modeled scenario of reducing opioids by one level (high to medium, medium to low, or low to none) and adding IV APAP, with an associated total LOS-related cost savings of $4.5 M. Modeled opioid-related complication rates showed similar improvements, averaging a reduction of 28.7% (5.4–44.0%) with associated cost savings of $0.2 M. In aggregate, costs decreased by an estimated $4.7 M for a medium-sized hospital. The study design demonstrates associations only and cannot establish causal relationships. The cost impact of LOS is modeled based on observed data.ConclusionsThis investigation indicates that reducing opioid use and including IV APAP for postoperative pain management has the potential to decrease LOS, opioid-related complication rates, and costs from a hospital perspective.FundingMallinckrodt Pharmaceuticals.

Reduced length of stay and hospitalization costs among inpatient hysterectomy patients with postoperative pain management including IV versus oral acetaminophen

“…These findings add to the real world evidence estimating the comparative effectiveness of IV versus oral APAP. Previous research of multimodal pain management including IV APAP versus opioid monotherapy also suggests that IV APAP for acute postoperative pain improves patient outcomes and reduces hospital resource use [ 35 – 39 ]. As health care practitioners move toward multimodal approaches to synergize distinct pain medications, increase analgesia, and reduce adverse events [ 2 ], this real world evidence is critical to help inform providers and hospital administrators about the clinical and economic benefits of IV APAP.…”

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] .…”

Cost‐effectiveness of intravenous acetaminophen and ketorolac in adolescents undergoing idiopathic scoliosis surgery

“…and LOS by 18.5% by the use of IV acetaminophen, with estimated cost savings of $4.5 million. 19 Another retrospective study evaluating the use of IV acetaminophen after spinal surgery reported decrease in postoperative opioid use, but they did not find decreased subsequent antiemetic or laxative use. 8 However, their study size was small (n = 34), and the acetaminophen doses were not standardized.…”

“…Our results are consistent with prior research findings in adults undergoing orthopedic surgeries, where use of IV acetaminophen was found to decrease costs and lower LOS . In adults undergoing obstetric, cardiovascular, colorectal, and orthopedic surgeries, authors report decreased opioid‐related complications by 28.7% and LOS by 18.5% by the use of IV acetaminophen, with estimated cost savings of $4.5 million . Another retrospective study evaluating the use of IV acetaminophen after spinal surgery reported decrease in postoperative opioid use, but they did not find decreased subsequent antiemetic or laxative use .…”