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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.

Publication ,  Journal Article
Hansen, RN; Pham, AT; Böing, EA; Lovelace, B; Wan, GJ; Miller, TE
Published in: Curr Med Res Opin
May 2017

BACKGROUND: Recovery from spine surgery is oriented toward restoring functional health outcomes while reducing resource use. Optimal pain management is a key to reaching these objectives. We compared outcomes of spine surgery patients who received standard pain management including intravenous (IV) acetaminophen (APAP) vs. oral APAP. METHODS: We performed a retrospective analysis of the Premier database (January 2012 to September 2015) comparing spine surgery patients who received pain management with IV APAP to those who received oral APAP, with no exclusions based on additional pain management. We performed multivariable logistic regression for the discharge and all cause 30-day readmission to the same hospital outcomes and instrumental variable regressions using the quarterly rate of IV APAP use for all hospitalizations by hospital as the instrument in two-stage least squares regressions for length of stay (LOS), hospitalization costs, and average daily morphine equivalent dose (MED) outcomes. Models adjusted for age, gender, race, admission type, 3M All Patient Refined Diagnosis Related Group severity of illness and risk of mortality, hospital size, and indicators for whether the hospital was an academic center and whether it was urban or rural. RESULTS: We identified 112,586 spine surgery patients with 51,835 (46%) having received IV APAP. Subjects averaged 57 and 59 years of age respectively in the IV APAP and oral APAP cohorts and were predominantly non-Hispanic Caucasians and female. In our adjusted models, IV APAP was associated with 0.68 days shorter LOS (95% CI: -0.76 to -0.59, p < .0001), $1175 lower hospitalization costs (95% CI: -$1611 to -$739, p < .0001), 13 mg lower average daily MED (95% CI: -14 mg to -12 mg, p < .0001), 34% lower risk of discharge to a skilled nursing facility (95% CI: 0.63 to 0.69, p < .0001), and 13% less risk of 30-day readmission (95% CI: 0.73 to 1.03). CONCLUSIONS: Compared to oral APAP, managing post-spine-surgery pain with IV APAP is associated with less resource use, lower costs, lower doses of opioids, and improved discharge status.

Duke Scholars

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Published In

Curr Med Res Opin

DOI

EISSN

1473-4877

Publication Date

May 2017

Volume

33

Issue

5

Start / End Page

943 / 948

Location

England

Related Subject Headings

  • Treatment Outcome
  • Retrospective Studies
  • Pain, Postoperative
  • Middle Aged
  • Male
  • Length of Stay
  • Injections, Intravenous
  • Humans
  • Hospitalization
  • Hospital Costs
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Hansen, R. N., Pham, A. T., Böing, E. A., Lovelace, B., Wan, G. J., & Miller, T. E. (2017). 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, 33(5), 943–948. https://doi.org/10.1080/03007995.2017.1297702
Hansen, Ryan N., An T. Pham, Elaine A. Böing, Belinda Lovelace, George J. Wan, and Timothy E. Miller. “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 33, no. 5 (May 2017): 943–48. https://doi.org/10.1080/03007995.2017.1297702.

Published In

Curr Med Res Opin

DOI

EISSN

1473-4877

Publication Date

May 2017

Volume

33

Issue

5

Start / End Page

943 / 948

Location

England

Related Subject Headings

  • Treatment Outcome
  • Retrospective Studies
  • Pain, Postoperative
  • Middle Aged
  • Male
  • Length of Stay
  • Injections, Intravenous
  • Humans
  • Hospitalization
  • Hospital Costs