BACKGROUND: Discussion remains on the value of intravenous acetaminophen (IV APAP) in postoperative pain management, especially given its high price. Small trials provide equivocal results on its opioid-sparing effects, necessitating a real-world, large-scale assessment. We sought to determine if IV APAP use is associated with reduced perioperative opioid utilization and opioid-related adverse effects in patients undergoing open colectomies.
METHODS: In this retrospective study we used national claims data (Premier Perspective) from January 2011 to December 2014 of 112,156 open colectomy patients (511 hospitals). IV APAP use was categorized as 1 (1000 mg), or >1 doses, on the day of surgery (D0), the day after (D1) or later (D1+). Multilevel, multivariable regressions measured associations between IV APAP use and (1) opioid utilization (in oral morphine equivalents, OME), and (2) opioid-related adverse effects.
RESULTS: Overall, 20% (n=22,612) of patients received IV APAP, of whom 48.8% (n=11,044) received only 1 dose on D0, while 10.0% (n=2,266) and 35.1% (n=7,945) received 1 and >1 dose on D1+, respectively. The use of IV APAP was associated with higher use of other non-opioid analgesics. Moreover, patients receiving IV APAP had a slightly lower mean comorbidity index when compared to patients not receiving IV APAP (2.13 versus 2.33; P<0.0001).
Multivariable analyses showed a pattern of modestly reduced opioid utilization paired with lower odds for opioid-related adverse effects particularly for >1 dose of IV APAP use on D0 (-7.7% CI -10.5;-4.7% decreased opioid utilization) and respiratory complications (OR 0.66 CI 0.58;0.75). IV APAP use beyond D1 was associated with up to 24% increased opioid utilization, with higher odds for opioid-related adverse effects.
CONCLUSION: In open colectomy patients, particularly >1 dose of IV APAP use on D0 appears to be associated with modest benefits in outcomes warranting further discussion on its value in light of other non-opioid analgesic options. Moreover, with 49% of patients receiving only one dose on D0, this further questions whether IV APAP is currently used in the most effective way.