Reduced length of stay and hospitalization costs among inpatient hysterectomy patients with postoperative pain management including IV versus oral acetaminophen

• Published in: PloS one Vol. 13; no. 9; p. e0203746
• Main Authors: Hansen, Ryan N, Pham, An T, Boing, Elaine A, Lovelace, Belinda, Wan, George J, Urman, Richard D
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 13-09-2018; Public Library of Science (PLoS)
• Subjects: Acetaminophen; Acetaminophen - administration & dosage; Acetaminophen - adverse effects; Acetaminophen - economics; Administration, Intravenous; Administration, Oral; Analgesics; Analgesics, Non-Narcotic - administration & dosage; Analgesics, Non-Narcotic - adverse effects; Analgesics, Non-Narcotic - economics; Bone surgery; Care and treatment; Complications and side effects; Control; Costs; Databases, Factual; Demographics; Demography; Dosage; Drug stores; Female; Health aspects; Health care costs; Health economics; Hospital costs; Hospital Costs - statistics & numerical data; Hospital stays; Hospitalization; Humans; Hysterectomy; Inpatients; Intestinal Diseases - etiology; Length of Stay - economics; Logistic Models; Management; Medicine and Health Sciences; Middle Aged; Morphine; Narcotics; Orthopedics; Pain; Pain management; Pain, Postoperative - drug therapy; Patients; Pharmaceuticals; Pharmacy; Physical Sciences; Postoperative complications; Postoperative period; Regression analysis; Research and Analysis Methods; Retrospective Studies; Risk analysis; Risk factors; Studies; Surgery; Systematic review; Uterine Diseases - surgery; San Francisco California; California; United States > US; New Jersey
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0203746

To compare the outcomes of hysterectomy patients who received standard pain management including IV acetaminophen (IV APAP) versus oral APAP.
We performed a retrospective analysis of the Premier Database (January 2012 to September 2015) comparing hysterectomy patients who received postoperative pain management including IV APAP to those who received oral APAP starting on the day of surgery and continuing up to the third post-operative day, with no exclusions based on additional pain management. We compared the groups on length of stay (LOS), hospitalization costs, and average daily morphine equivalent dose (MED). The quarterly rate of IV APAP use for all hospitalizations by hospital was used as an instrumental variable in two-stage least squares regressions also adjusting for patient demographics, clinical risk factors, and hospital characteristics.
We identified 22,828 hysterectomy patients including 14,811 (65%) who had received IV APAP. Study subjects averaged 50 and 52 years of age, respectively in the IV APAP and oral APAP cohorts and were predominantly non-Hispanic Caucasians (≥60% in both cohorts). Instrumental variable models found IV APAP associated with 0.8 days shorter hospitalization (95% CI: -0.92 to -0.68, p<0.0001) and $2,449 lower hospitalization costs (95% CI: -$2,902 to -$1,996, p<0.0001). Average daily MED trended lower without statistical significance (-1.41 mg, 95% CI: -3.43 mg to 0.61 mg, p = 0.17).
Compared to oral APAP, managing post-hysterectomy pain with IV APAP is associated with shorter LOS and lower total hospitalization costs.