161 posters,  34 sessions,  7 topics,  1004 authors 

ePostersLive® by SciGen® Technologies S.A. All rights reserved.

4328
Intravenous acetaminophen use associated with reduced odds of 30-day readmission after total knee arthroplasty
Session: EX-11
Fri, Nov. 17, 4:30-4:45 pm
Screen D

Please note, medically challenging cases are removed three months after the meeting and scientific abstracts after three years.

Rate

No votes yet

Intravenous acetaminophen use associated with reduced odds of 30-day readmission after total knee arthroplasty

Introduction

Increasing number of studies on acetaminophen (APAP) for pain control across surgical types [1-5]

Previously, intravenous (IV) formulation  was shown to be more effective than oral (PO) [5]

However, IV formulation is associated with higher costs

Cost and quality of care is important in light of new reimbursement models

However, if IV APAP is associated with lower pain levels, it may potentially decrease readmission rates due to complications

Objectives:

To compare total knee arthroplasty (TKA) patients who received either IV APAP or oral APAP:

30-day readmission rates

Correlated to other reports on readmissions

Extrapolated potential cost savings on a National Level

Methods

Data source, timeframe, and study cohort

•Premier™ database
•Compared TKA patients who received either IV APAP or oral APAP
•Day of surgery to postoperative day 3
•Between 2012 and 2015
•IV APAP n= 56,475,  PO APAP n= 134,216
•Literature review on 30-day readmission and prediction tools
•Extrapolation of cost savings on National Level performed
•IRB approval obtained from University of Washington by self-determination

Outcomes

•All cause 30-day readmissions to the same hospital recorded

Statistical analysis

•Inverse probability of treatment (propensity score) weighted regression was performed to assess the association between IV APAP and 30-day readmission
 
Overall Results Summary

In adjusted model, risk of 30-day readmission was 71% less likely in the IV APAP than the PO APAP cohort (OR 0.29, 95% CI 0.23 to 0.35; p<0.001)

Nationwide utilization of IV APAP in TKA may potentially result in $260 million in savings/year

Lower 30-day readmission rates in IV cohort when compared to other studies

Discussion

Reduced 30-day readmission rates in TKA patients who received IV vs. PO APAP

 

Overall lower 30-day readmission rates when compared to literature

 

Potential to save $260 million if implemented nationwide

 

Valuable information for orthopaedic surgeons and healthcare administrators 

References

1.Hansen RN, Pham AT, Böing EA, Lovelace B, Wan GJ, Miller TE. 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. Curr Med Res Opin 2017;33:943–8. doi:10.1080/03007995.2017.1297702.
2.Murata-Ooiwa M, Tsukada S, Wakui M. Intravenous Acetaminophen in Multimodal Pain Management for Patients Undergoing Total Knee Arthroplasty: A Randomized, Double-Blind, Placebo-Controlled Trial. J Arthroplasty 2017. doi:10.1016/j.arth.2017.05.013.
3.Maiese BA, Pham AT, Shah M V, Eaddy MT, Lunacsek OE, Wan GJ. Hospitalization Costs for Patients Undergoing Orthopedic Surgery Treated With Intravenous Acetaminophen (IV-APAP) Plus Other IV Analgesics or IV Opioid Monotherapy for Postoperative Pain. Adv Ther 2017;34:421–35. doi:10.1007/s12325-016-0449-8.
4.El Chaar M, Stoltzfus J, Claros L, Wasylik T. IV Acetaminophen Results in Lower Hospital Costs and Emergency Room Visits Following Bariatric Surgery: a Double-Blind, Prospective, Randomized Trial in a Single Accredited Bariatric Center. J Gastrointest Surg 2016;20:715–24. doi:10.1007/s11605-016-3088-0.
5.Bollinger AJ, Butler PD, Nies MS, Sietsema DL, Jones CB, Endres TJ. Is scheduled intravenous acetaminophen effective in the pain management protocol of geriatric hip fractures?. Geriatric orthopaedic surgery & rehabilitation. 2015 Sep;6(3):202-8.
6.Kiridly DN, Karkenny AJ, Hutzler LH, Slover JD, Iorio R, Bosco JA. The Effect of Severity of Disease on Cost Burden of 30-Day Readmissions Following Total Joint Arthroplasty (TJA). J Arthroplasty 2014;29:1545–7. doi:10.1016/j.arth.2014.03.035.
7.Minhas S V, Kester BS, Lovecchio FC, Bosco JA. Nationwide 30-Day Readmissions After Elective Orthopedic Surgery: Reasons and Implications. J Healthc Qual 2017;39:34–42. doi:10.1097/JHQ.0000000000000045.
8.Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007;89:780–5. doi:10.2106/JBJS.F.00222.
9.Cherian J, Issa K, Robinson K, Bhowmik-Stoker M, Harwin S, Mont M. Differences in Readmission Rates for Two Total Knee Arthroplasty Prostheses. J Knee Surg 2014;28:201–6. doi:10.1055/s-0034-1376331
10.Issa K, Cherian J, Kapadia B, Robinson K, Bhowmik-Stoker M, Harwin S, et al. Readmission Rates for Cruciate-Retaining Total Knee Arthroplasty. J Knee Surg 2014;28:239–42. doi:10.1055/s-0034-1378194.
11.Drager J, Hart A, Khalil JA, Zukor DJ, Bergeron SG, Antoniou J. Shorter Hospital Stay and Lower 30-Day Readmission After Unicondylar Knee Arthroplasty Compared to Total Knee Arthroplasty. J Arthroplasty 2016;31:356–61. doi:10.1016/j.arth.2015.09.014.
12.Hart A, Antoniou J, Brin YS, Huk OL, Zukor DJ, Bergeron SG. Simultaneous Bilateral Versus Unilateral Total Knee Arthroplasty: A Comparison of 30-Day Readmission Rates and Major Complications. J Arthroplasty 2016;31:31–5. doi:10.1016/j.arth.2015.07.031.



Enter Poster ID (e.gGoNextPreviousCurrent