Widespread Impact of Reducing Opioids, Adding IV Acetaminophen for Postsurgical Pain Management

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Reducing opioid administration by 1 level in combination with the use of IV APAP led to an average 18.5% reduction in length of hospital stay.
Reducing opioid administration by 1 level in combination with the use of IV APAP led to an average 18.5% reduction in length of hospital stay.

Postoperative pain management that combines a reduction in opioid medications with the use of intravenous acetaminophen (IV APAP) may shorten hospital length of stay, reduce the rate of complications related to opioids, and lower related costs, according to a study in Advances in Therapy.

Investigators retrospectively evaluated de-identified data from 2,238,433 inpatient encounters across 297 hospitals during a 2-year period. A total of 271,394 of those patients (12.1%) had been treated with IV-APAP. Patients included in the study were age ≥18 years and had been admitted for cardiovascular, colorectal, general, obstetric and gynecologic, orthopedic, or spinal surgery.

Reducing opioid administration by 1 level (ie, from high [>8 estimated doses or >3 days' use] to medium [4-8 estimated doses or 3 days' use]; medium to low [1-3 estimated doses for 1 or 2 days]; or low to none) in combination with the use of IV APAP, led to an average 18.5% reduction in length of hospital stay (range, 10.7%-32.0%), and an associated $4.5 million in cost savings. In addition, such measures resulted in a 28.7% reduction of opioid-related complication rates (range, 5.4%-44.0) and an associated cost savings estimated at $0.2 million. The savings for an average-sized hospital is estimated at $4.7 million.

Considering this study was retrospective and observational in nature, no causative associations can be drawn between opioid reduction plus use of IV APAP and reductions in hospital length of stay, complications, and healthcare costs.

“Prevention of [opioid-related adverse drug events] rather than treatment of [adverse drug events] is a more effective strategy for hospitals, given the large economic burden and negative impact on patient outcomes associated with these events,” concluded the study authors.

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Reference

Shaffer EE, Pham A, Woldman RL, et al. Estimating the effect of intravenous acetaminophen for postoperative pain management on length of stay and inpatient hospital costs. Adv Ther. 2016;33(12):2211-2228.

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