Postoperative management of adolescents undergoing posterior spinal fusion surgery with intravenous acetaminophen (IV APAP) may have an opioid-sparing effect resulting from a reduced hospital length of stay (LOS), according to a study published in the Clinical Journal of Pain.
Researchers prospectively enrolled 114 patients aged 10 to 18 years (68.42% girls) undergoing elective posterior spinal fusion for idiopathic scoliosis and/or kyphosis.
Postoperative pain management consisted of patient-controlled analgesia and adjuvant therapy, with 70 patients receiving IV APAP perioperatively, and 44 control patients.
Patients in the control vs IV APAP group had a longer anesthesia time (P <.001) and received higher amounts of remifentanil (P =.024). Oral intake (ie, “initial postoperative day on which 50% of meals were tolerated”) occurred sooner in patients administered IV APAP vs controls (1.98±1.70 vs 2.86±2.43; P <.001), and hospital length of stay was shorter in the treatment group vs the control group (4.54±1.44 vs 5.10±1.29; P =.044), although this difference no longer held after inverse probability of treatment weighing. However, the “mediation effect” on the association between hospital length of stay and IV APAP administration of morphine consumption was significant (P =.013).
A negative association was established between IV APAP and morphine consumption (P <.001), which also increased hospital length of stay (P <.003).
The main limitations of this study include its nonrandomized and observational design. Also, the 2 groups used in this analysis differed in terms of surgery duration, ketorolac administration, and remifentanil doses, further reducing the power of the findings.
Using IV APAP may be an integral strategy that can decrease hospital length of stay, which is particularly important, “given recent trends indicating a transition from traditional ‘fee-for-service’ models to ‘bundled payments’ whereby health care providers are encouraged to deliver care more efficiently while improving quality, cost, and outcomes.”
Olbrecht VA, Ding L, Spruance K, et al. Intravenous acetaminophen reduces length of stay via mediation of postoperative opioid consumption following posterior spinal fusion in a pediatric cohort [published online December 1, 2017]. Clin J Pain. doi: 10.1097/AJP.0000000000000576