Impact of Intravenous Acetaminophen on Lengths of Stay and Discharge Status after Total Knee Arthroplasty

Barrington, John W.; Hansen, Ryan N.; Lovelace, Belinda; Boing, E.; Chughtai, Morad; Newman, Jared M.; Pham, An; Khlopas, Anton; Sodhi, Nipun; Sultan, Assem A.; Mont, Michael A.

doi:10.1055/s-0038-1636908

Cited by 9 publications

(7 citation statements)

References 20 publications

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“…This protocol takes advantage of multiple medications, including nonsteroidal anti-inflammatory drugs (NSAIDs), selective cyclooxygenase-2 (COX-2) inhibitors, acetaminophen, and glucocorticoids, that exert their mechanisms of action on different targets of the pain pathway. Intraoperative intravenous acetaminophen and a periarticular cocktail injection containing liposomal bupivacaine have been demonstrated to result in a reduced need for postoperative opioids and fewer postoperative complications after TJA [19][20][21][22][23][24][25][26][27][28][29]. Postoperatively and on discharge, a standing dose of 1 g of oral acetaminophen every 6-8 hours was used for preemptive analgesia.…”

Section: Discussionmentioning

confidence: 99%

Similar Outcomes After Hospital-Based Same-Day Discharge vs Inpatient Total Hip Arthroplasty

et al. 2020

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Background: There has been increasing interest in performing primary hip and knee replacement with same-day discharge (SDD). The purpose of this study is to compare patient-reported outcome (PRO) scores, pain scores, and readmissions in patients who underwent SDD total hip arthroplasty (THA) with those in patients who underwent traditional inpatient THA. Methods: A retrospective study was conducted on 963 patients who underwent primary THA at our institution between September 2016 and December 2018. Two cohorts were established based on whether the patient underwent SDD or traditional inpatient THA. An electronic physical engagement application was used to collect PRO scores (Hip Disability and Osteoarthritis Outcome Score for Joint Replacement, Veterans Rand 12-Item Health Survey Physical Component Score, and Mental Component Score) and pain scores. To control for demographic variables, a multiple regression analysis of PRO scores was conducted. Results: Four hundred fifteen (43.1%) patients in this study underwent the SDD protocol. There were significant differences between both cohorts with respect to sex, age, body mass index, American Society of Anesthesiologists score, and smoking status. The bivariate analysis revealed that the SDD cohort had a significantly greater change in the Veterans Rand 12-Item Health Survey Physical Component Score and had fewer readmissions. Both cohorts had equivalent decreases in pain scores. After controlling for demographic variables in a multivariable analysis, the SDD cohort was found to have higher PRO scores at all time points, but there were no significant differences in the change in PRO scores over time between both groups. Conclusions: Patients in an SDD THA care pathway experienced similar improvements in PRO scores and clinically equal reduction in pain scores.

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Section: Discussionmentioning

confidence: 99%

Similar Outcomes After Hospital-Based Same-Day Discharge vs Inpatient Total Hip Arthroplasty

et al. 2020

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“…Barrington et al also performed a retrospective review of the Premier database and evaluated the postoperative outcomes of patients who received IV versus oral acetaminophen after undergoing total knee arthroplasty. 15 This study demonstrated that when compared with the oral group, patients who received IV acetaminophen had a shorter length of stay (0.14 days, P < .001), 13% lower chance of discharge to a skilled nursing facility (P < .001), and a 22% higher likelihood of being discharged to home (P < .001). Apfel et al also performed a retrospective matched-pairs analysis of the Premier database, evaluating patients who underwent total hip or total knee arthroplasty with each patient who received IV acetaminophen on the day of surgery being matched to a patient who did not receive IV acetaminophen during that hospitalization.…”

Section: Discussionmentioning

confidence: 74%

Treatment With Oral Versus Intravenous Acetaminophen in Elderly Trauma Patients With Rib Fractures: A Prospective Randomized Trial

Antill

Frye

McMillen

et al. 2020

The American Surgeon™

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Background Rib fractures are common injuries among traumatically injured patients, and elderly patients with rib fractures are at increased risk for adverse events and death. The purpose of this study was to determine if oral Per os (PO) acetaminophen is as effective as intravenous (IV) acetaminophen in treating the pain associated with rib fractures. Methods We performed a single-center, randomized, placebo-controlled, double-blinded study. Trauma patients who were ≥65 years old and had ≥1 rib fracture were included in this study. Patients were randomized into IV acetaminophen and oral placebo (n = 63) or IV placebo and oral solution acetaminophen (n = 75) groups. The primary outcome was a mean reduction in pain score at 24 hours, and secondary outcomes included opioid use, intensive care unit (ICU) length of stay (LOS), hospital LOS, hospital mortality, the difference in incentive spirometry, and development of pneumonia. Results Among the 138 patients included, there was no statistically significant difference between the 2 study groups in a mean reduction in pain score at 24 hours after injury (PO: 3.24, IV: 2.49; P = .230). Opioid pain medication use was equivalent between groups ( P = .212), and there was no significant difference in hospital mortality rate between groups ( P = .827). There was no statistically significant difference in ICU LOS, hospital LOS, or development of pneumonia. Discussion In elderly trauma patients (age ≥65 years) with 1 or more rib fractures, PO acetaminophen is equivalent to IV acetaminophen for pain control, with no difference in morbidity or mortality. Oral acetaminophen should be preferentially used over IV acetaminophen when treating the elderly trauma patient with rib fractures.

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“…However, the higher cost of individual IV APAP dose was not included in the cost calculation, and may decrease the overall savings. Another study is underway comparing LOS and discharge disposition between those who received IV and PO APAP 45 Prospective randomized controlled studies are needed to verify these results. Future studies should assess costs, LOS, and discharge status in patients who use IV APAP.…”

Section: Resultsmentioning

confidence: 99%

Intravenous Acetaminophen May Be Associated with Reduced Odds of 30-Day Readmission after Total Knee Arthroplasty

et al. 2018

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The purpose of this study was (1) to evaluate 30-day readmission rates in total knee arthroplasty (TKA) patients who either received intravenous (IV) or oral (PO) acetaminophen (APAP) perioperatively and (2) to extrapolate the potential annual cost savings on the national level. This was a review of 190,691 TKA recipients between the years 2012 and 2015 who received either IV ( = 56,475) or PO APAP ( = 134,216). All-cause readmissions that occurred between patient discharge and 30 days postdischarge were recorded. Continuous and categorical variables were evaluated using -test and chi-square test, respectively. A logistic regression analysis was conducted to assess the effect of IV APAP on 30-day readmission. We also performed a literature review on 30-day readmission rates and risk prediction tools for TKA and correlated these with our findings. In addition, we extrapolated potential cost savings on the national level. The readmission rate was 0.04% in the IV and 0.14% in the PO APAP cohort (69% decreased risk; odds ratio = 0.31; 95% confidence interval = 0.20-0.47; < 0.001). The readmission rate in this patient population appears to be markedly lower, when compared with previous reports. This reduction in readmissions may potentially result in $160 million savings per year. The use of IV APAP in TKA patients resulted in lower readmission rates, which may be valuable in clinical decision making by surgeons and health care administrators looking to lower costs of care.

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Impact of Intravenous Acetaminophen on Lengths of Stay and Discharge Status after Total Knee Arthroplasty

Cited by 9 publications

References 20 publications

Similar Outcomes After Hospital-Based Same-Day Discharge vs Inpatient Total Hip Arthroplasty

Similar Outcomes After Hospital-Based Same-Day Discharge vs Inpatient Total Hip Arthroplasty

Treatment With Oral Versus Intravenous Acetaminophen in Elderly Trauma Patients With Rib Fractures: A Prospective Randomized Trial

Intravenous Acetaminophen May Be Associated with Reduced Odds of 30-Day Readmission after Total Knee Arthroplasty

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