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

Abstract

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.

Drug Utilization for Pain Management during Perioperative Period of Total Knee Arthroplasty in China: A Retrospective Research Using Real-World Data

“…Acetaminophen, as an analgesic, is often used to assist the analgesic effect of other drugs. Murata-ooiwa M et al [ 18 ] and Mont Ma et al [ 39 ] both confirmed the effect of acetaminophen on the pain management after TKA surgeryin achieving effective pain control for the patients. Mont Ma et al [ 39 ] had also confirmed that the use of acetaminophen could reduce the probability of reoperation and save the cost of patients.…”

“…Other types of analgesics, such as pregabalin was also used by the patients in this study. Some research results showed that while this other type of analgesics such as gabapentin and pregabalin could alleviate postoperative pain and reduce the use of opioids [ 39 , 40 ], the adverse reactions and effectiveness of the drugs have yet to be confirmed [ 41 , 42 , 43 , 44 ]. How to avoid adverse reactions of analgesics in TKA needs more clinical research.…”

Systematic Review of Systemic and Neuraxial Effects of Acetaminophen in Preclinical Models of Nociceptive Processing

“… 44 IV acetaminophen reduced the likelihood of readmission after 30 days following knee arthroscopy. 45 This raises the possibility that the actions of acetaminophen reflect disease modifying actions that alter the transition from an acute to a chronic pain state hypothesized to reflect a role of innate/adaptive immune systems. 46 Less promising results have also been reported, 47 concerns of toxicity remain 48 and the superiority of IV vs PO acetaminophen has been questioned.…”