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J Knee Surg 2019; 32(05): 414-420
DOI: 10.1055/s-0038-1646927
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Intravenous Acetaminophen May Be Associated with Reduced Odds of 30-Day Readmission after Total Knee Arthroplasty

Michael A. Mont
1   Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, New York
,
Belinda Lovelace
2   Department of Health Economics and Outcomes Research, Mallinckrodt Pharmaceuticals, Bedminster, New Jersey
,
An T. Pham
3   School of Pharmacy, University of California, San Francisco, California
,
Ryan N. Hansen
4   School of Pharmacy, University of Washington, Seattle, Washington
,
Morad Chughtai
1   Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, New York
,
Chukwuweike U. Gwam
5   Department of Orthopaedic Surgery, Rubin Institute of Advanced Orthopedics, Baltimore, Maryland
,
Anton Khlopas
1   Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, New York
,
John W. Barrington
6   Department of Orthopaedic Surgery, Joint Replacement Center of Texas, Plano, Texas
› Author Affiliations
Further Information

Publication History

09 January 2018

20 March 2018

Publication Date:
07 May 2018 (online)

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Abstract

The purpose of this study was (1) to evaluate 30-day readmission rates in total knee arthroplasty (TKA) patients who either received intravenous (IV) or oral (PO) acetaminophen (APAP) perioperatively and (2) to extrapolate the potential annual cost savings on the national level. This was a review of 190,691 TKA recipients between the years 2012 and 2015 who received either IV (n = 56,475) or PO APAP (n = 134,216). All-cause readmissions that occurred between patient discharge and 30 days postdischarge were recorded. Continuous and categorical variables were evaluated using t-test and chi-square test, respectively. A logistic regression analysis was conducted to assess the effect of IV APAP on 30-day readmission. We also performed a literature review on 30-day readmission rates and risk prediction tools for TKA and correlated these with our findings. In addition, we extrapolated potential cost savings on the national level. The readmission rate was 0.04% in the IV and 0.14% in the PO APAP cohort (69% decreased risk; odds ratio = 0.31; 95% confidence interval = 0.20–0.47; p < 0.001). The readmission rate in this patient population appears to be markedly lower, when compared with previous reports. This reduction in readmissions may potentially result in $160 million savings per year. The use of IV APAP in TKA patients resulted in lower readmission rates, which may be valuable in clinical decision making by surgeons and health care administrators looking to lower costs of care.

Keywords

intravenous acetaminophen - readmission - total knee arthroplasty - acetaminophen

Note

An T. Pham, PharmD, MBA, FAHA, was an employee of Mallinckrodt Pharmaceuticals at the time of the study.


 

  • References

  • 1 Jauregui JJ, Cherian JJ, Gwam CU. , et al. Prediction of postoperative pain by preoperative pain response to heat stimulation in total knee arthroplasty. J Arthroplasty 2016; 29 (04) 2402-2407
    PubMedGoogle Scholar
  • 2 Grosu I, Thienpont E, De Kock M, Scholtes JL, Lavand'homme P. Dynamic view of postoperative pain evolution after total knee arthroplasty: a prospective observational study. Minerva Anestesiol 2016; 82 (03) 274-283
    PubMedGoogle Scholar
  • 3 Follin SL, Charland SL. Acute pain management: operative or medical procedures and trauma. Ann Pharmacother 1997; 31 (09) 1068-1076
    CrossrefPubMedGoogle Scholar
  • 4 Maheshwari AV, Blum YC, Shekhar L, Ranawat AS, Ranawat CS. Multimodal pain management after total hip and knee arthroplasty at the Ranawat Orthopaedic Center. Clin Orthop Relat Res 2009; 467 (06) 1418-1423
    CrossrefPubMedGoogle Scholar
  • 5 Parvataneni HK, Ranawat AS, Ranawat CS. The use of local periarticular injections in the management of postoperative pain after total hip and knee replacement: a multimodal approach. Instr Course Lect 2007; 56: 125-131
    PubMedGoogle Scholar
  • 6 Sinatra RS, Torres J, Bustos AM. Pain management after major orthopaedic surgery: current strategies and new concepts. J Am Acad Orthop Surg 2002; 10 (02) 117-129
    CrossrefPubMedGoogle Scholar
  • 7 Marchand RC, Sodhi N, Khlopas A. , et al. Coronal correction for severe deformity using robotic-assisted total knee arthroplasty. J Knee Surg 2018; 31 (01) 2-5
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 Marchand RC, Sodhi N, Khlopas A. , et al. Patient satisfaction outcomes after robotic arm-assisted total knee arthroplasty: a short-term evaluation. J Knee Surg 2017; 30 (09) 849-853
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Gwam CU, Mistry JB, Delanois RE. , et al. Does patient perception of pain influence how patients rate their experience after total knee arthroplasty?. J Knee Surg 2017; 30 (07) 622-626
    Article in Thieme ConnectPubMedGoogle Scholar
  • 10 Chughtai M, Jauregui JJ, Mistry JB. , et al. What influences how patients rate their hospital after total knee arthroplasty?. Surg Technol Int 2016; 28: 261-265
    PubMedGoogle Scholar
  • 11 Filos KS, Lehmann KA. Current concepts and practice in postoperative pain management: need for a change?. Eur Surg Res 1999; 31 (02) 97-107
    PubMedGoogle Scholar
  • 12 Parvizi J, Porat M, Gandhi K, Viscusi ER, Rothman RH. Postoperative pain management techniques in hip and knee arthroplasty. Instr Course Lect 2009; 58: 769-779
    PubMedGoogle Scholar
  • 13 Mangano DT, Wong MG, London MJ, Tubau JF, Rapp JA. ; The Study of Perioperative Ischemia (SPI) Research Group. Perioperative myocardial ischemia in patients undergoing noncardiac surgery--II: incidence and severity during the 1st week after surgery. J Am Coll Cardiol 1991; 17 (04) 851-857
    CrossrefPubMedGoogle Scholar
  • 14 Wisner DH. A stepwise logistic regression analysis of factors affecting morbidity and mortality after thoracic trauma: effect of epidural analgesia. J Trauma 1990; 30 (07) 799-804
    CrossrefPubMedGoogle Scholar
  • 15 Krych AJ, Horlocker TT, Hebl JR, Pagnano MW. Contemporary pain management strategies for minimally invasive total knee arthroplasty. Instr Course Lect 2010; 59: 99-109
    PubMedGoogle Scholar
  • 16 Parvataneni HK, Shah VP, Howard H, Cole N, Ranawat AS, Ranawat CS. Controlling pain after total hip and knee arthroplasty using a multimodal protocol with local periarticular injections: a prospective randomized study. J Arthroplasty 2007; 22 (06) (Suppl. 02) 33-38
    CrossrefPubMedGoogle Scholar
  • 17 Korean Knee Society. Guidelines for the management of postoperative pain after total knee arthroplasty. Knee Surg Relat Res 2012; 24 (04) 201-207
    CrossrefPubMedGoogle Scholar
  • 18 Morrone LA, Scuteri D, Rombolà L, Mizoguchi H, Bagetta G. Opioids resistance in chronic pain management. Curr Neuropharmacol 2017; 15 (03) 444-456
    CrossrefPubMedGoogle Scholar
  • 19 Wheeler M, Oderda GM, Ashburn MA, Lipman AG. Adverse events associated with postoperative opioid analgesia: a systematic review. J Pain 2002; 3 (03) 159-180
    CrossrefPubMedGoogle Scholar
  • 20 Ranawat AS, Ranawat CS. Pain management and accelerated rehabilitation for total hip and total knee arthroplasty. J Arthroplasty 2007; 22 (07) (Suppl. 03) 12-15
    CrossrefPubMedGoogle Scholar
  • 21 Bosco III JA, Karkenny AJ, Hutzler LH, Slover JD, Iorio R. Cost burden of 30-day readmissions following Medicare total hip and knee arthroplasty. J Arthroplasty 2014; 29 (05) 903-905
    CrossrefPubMedGoogle Scholar
  • 22 Levine JM, Khlopas A, Sodhi N. , et al. The association between readmission and patient experience in a total hip arthroplasty population. J Arthroplasty 2017; DOI: 10.1016/j.arth.2017.12.023.
    CrossrefPubMedGoogle Scholar
  • 23 Freedman DA, Berk RA. Weighting regressions by propensity scores. Eval Rev 2008; 32 (04) 392-409
    CrossrefPubMedGoogle Scholar
  • 24 Kiridly DN, Karkenny AJ, Hutzler LH, Slover JD, Iorio R, Bosco III JA. The effect of severity of disease on cost burden of 30-day readmissions following total joint arthroplasty (TJA). J Arthroplasty 2014; 29 (08) 1545-1547
    CrossrefPubMedGoogle Scholar
  • 25 Minhas SV, Kester BS, Lovecchio FC, Bosco JA. Nationwide 30-day readmissions after elective orthopedic surgery: reasons and implications. J Healthc Qual 2017; 39 (01) 34-42
    CrossrefPubMedGoogle Scholar
  • 26 Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007; 89 (04) 780-785
    CrossrefPubMedGoogle Scholar
  • 27 News &amp; Media | Mallinckrodt Pharmaceuticals. Available at: http://www.mallinckrodt.com/about/news-and-media/2280748 . Accessed March 1, 2018
    PubMedGoogle Scholar
  • 28 Morris BJ, Mir HR. The opioid epidemic: impact on orthopaedic surgery. J Am Acad Orthop Surg 2015; 23 (05) 267-271
    CrossrefPubMedGoogle Scholar
  • 29 Bernatz JT, Tueting JL, Anderson PA. Thirty-day readmission rates in orthopedics: a systematic review and meta-analysis. PLoS One 2015; 10 (04) e0123593
    CrossrefPubMedGoogle Scholar
  • 30 Hansen RN, Pham AT, Böing EA, Lovelace B, Wan GJ, Miller TE. 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 2017; 33 (05) 943-948
    CrossrefPubMedGoogle Scholar
  • 31 Murata-Ooiwa M, Tsukada S, Wakui M. Intravenous acetaminophen in multimodal pain management for patients undergoing total knee arthroplasty: a randomized, double-blind, placebo-controlled trial. J Arthroplasty 2017; 32 (10) 3024-3028
    CrossrefPubMedGoogle Scholar
  • 32 Maiese BA, Pham AT, Shah MV, Eaddy MT, Lunacsek OE, Wan GJ. Hospitalization costs for patients undergoing orthopedic surgery treated with intravenous acetaminophen (IV-APAP) plus other IV analgesics or IV opioid monotherapy for postoperative pain. Adv Ther 2017; 34 (02) 421-435
    CrossrefPubMedGoogle Scholar
  • 33 Mesko NW, Bachmann KR, Kovacevic D, LoGrasso ME, O'Rourke C, Froimson MI. Thirty-day readmission following total hip and knee arthroplasty - a preliminary single institution predictive model. J Arthroplasty 2014; 29 (08) 1532-1538
    CrossrefPubMedGoogle Scholar
  • 34 Mu Y, Edwards JR, Horan TC, Berrios-Torres SI, Fridkin SK. Improving risk-adjusted measures of surgical site infection for the national healthcare safety network. Infect Control Hosp Epidemiol 2011; 32 (10) 970-986
    CrossrefPubMedGoogle Scholar
  • 35 Berbari EF, Osmon DR, Lahr B. , et al. The Mayo prosthetic joint infection risk score: implication for surgical site infection reporting and risk stratification. Infect Control Hosp Epidemiol 2012; 33 (08) 774-781
    CrossrefPubMedGoogle Scholar
  • 36 Bozic KJ, Ong K, Lau E. , et al. Estimating risk in Medicare patients with THA: an electronic risk calculator for periprosthetic joint infection and mortality. Clin Orthop Relat Res 2013; 471 (02) 574-583
    CrossrefPubMedGoogle Scholar
  • 37 Healthgrades Mortality and Complications Outcomes 2016 Methodology. Available at: https://d26ua9paks4zq.cloudfront.net/dd/07/912812e54002b3ae345af71239be/pdf-methodology-mortality-and-complications-outcomes.pdf . Accessed August 2, 2017
    PubMedGoogle Scholar
  • 38 Wuerz TH, Kent DM, Malchau H, Rubash HE. A nomogram to predict major complications after hip and knee arthroplasty. J Arthroplasty 2014; 29 (07) 1457-1462
    CrossrefPubMedGoogle Scholar
  • 39 Lungu E, Desmeules F, Dionne CE, Belzile EL, Vendittoli P-A. Prediction of poor outcomes six months following total knee arthroplasty in patients awaiting surgery. BMC Musculoskelet Disord 2014; 15 (01) 299
    CrossrefPubMedGoogle Scholar
  • 40 Oldmeadow LB, McBurney H, Robertson VJ. Predicting risk of extended inpatient rehabilitation after hip or knee arthroplasty. J Arthroplasty 2003; 18 (06) 775-779
    CrossrefPubMedGoogle Scholar
  • 41 Bilimoria KY, Liu Y, Paruch JL. , et al. Development and evaluation of the universal ACS NSQIP surgical risk calculator: a decision aid and informed consent tool for patients and surgeons. J Am Coll Surg 2013; 217 (05) 833-842
    CrossrefPubMedGoogle Scholar
  • 42 El Chaar M, Stoltzfus J, Claros L, Wasylik T. IV acetaminophen results in lower hospital costs and emergency room visits following bariatric surgery: a double-blind, prospective, randomized trial in a Single Accredited Bariatric Center. J Gastrointest Surg 2016; 20 (04) 715-724
    CrossrefPubMedGoogle Scholar
  • 43 Boulding W, Glickman SW, Manary MP, Schulman KA, Staelin R. Relationship between patient satisfaction with inpatient care and hospital readmission within 30 days. Am J Manag Care 2011; 17 (01) 41-48
    PubMedGoogle Scholar
  • 44 Hachem F, Canar J, Fullam FM. , et al. The relationships between HCAHPS communication and discharge satisfaction items and hospital readmissions. Patient Exp J 2014; 1 (02) 71-77
    PubMedGoogle Scholar
  • 45 Barrington JW, Hansen RN, Lovelace B. , et al. Impact of intravenous acetaminophen on lengths of stay and discharge status after total knee arthroplasty. J Knee Surg 2018; DOI: 10.1055/s-0038-1636908.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 46 Cherian J, Issa K, Robinson K, Bhowmik-Stoker M, Harwin S, Mont M. Differences in Readmission Rates for Two Total Knee Arthroplasty Prostheses. J Knee Surg 2014; 28 (03) 201-206
    Article in Thieme ConnectPubMedGoogle Scholar
  • 47 Issa K, Cherian J, Kapadia B. , et al. Readmission Rates for Cruciate-Retaining Total Knee Arthroplasty. J Knee Surg 2014; 28 (03) 239-242
    Article in Thieme ConnectPubMedGoogle Scholar
  • 48 Drager J, Hart A, Khalil JA, Zukor DJ, Bergeron SG, Antoniou J. Shorter Hospital Stay and Lower 30-Day Readmission After Unicondylar Knee Arthroplasty Compared to Total Knee Arthroplasty. J Arthroplasty 2016; 31 (02) 356-361
    CrossrefPubMedGoogle Scholar
  • 49 Hart A, Antoniou J, Brin YS, Huk OL, Zukor DJ, Bergeron SG. Simultaneous Bilateral Versus Unilateral Total Knee Arthroplasty: A Comparison of 30-Day Readmission Rates and Major Complications. J Arthroplasty 2016; 31 (01) 31-35
    PubMedGoogle Scholar