Effectiveness of intravenous acetaminophen for postoperative pain management in shoulder arthroplasties: A population-based study
Background: Intravenous acetaminophen (IV APAP) is an option in multimodal postoperative analgesia. Prior trials focus on hip and knee arthroplasties, whereas large-scale data on utilization and effectiveness in shoulder arthroplasties are lacking. Methods: Data on 67,494 (452 hospitals) partial/tot...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2019-07-01
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| Series: | Journal of Orthopaedic Translation |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2214031X18300846 |
| _version_ | 1818322257487855616 |
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| author | Diana C. Patterson Paul J. Cagle, Jr. Jashvant Poeran Nicole Zubizarreta Madhu Mazumdar Leesa M. Galatz Shawn G. Anthony |
| author_facet | Diana C. Patterson Paul J. Cagle, Jr. Jashvant Poeran Nicole Zubizarreta Madhu Mazumdar Leesa M. Galatz Shawn G. Anthony |
| author_sort | Diana C. Patterson |
| collection | DOAJ |
| description | Background: Intravenous acetaminophen (IV APAP) is an option in multimodal postoperative analgesia. Prior trials focus on hip and knee arthroplasties, whereas large-scale data on utilization and effectiveness in shoulder arthroplasties are lacking. Methods: Data on 67,494 (452 hospitals) partial/total shoulder arthroplasties were extracted from the Premier claims database (2011–2016). Patients were categorized by receipt and dosage of IV APAP. Multilevel models measured associations between IV APAP and opioid utilization (in oral morphine equivalents), length/cost of stay and opioid-related complications. Effect estimates (adjusted % change) with 95% confidence intervals (CIs) are reported. Results: IV APAP was used in 17.7% (n = 11,949) of patients with an increasing utilization trend. Most patients received only one dose on the day of surgery (69.5%; n = 8308). When adjusting for relevant covariates, IV APAP was not associated with meaningful effects on outcomes. Specifically, its use (versus no use) was not associated with decreased (but rather somewhat increased) opioid utilization: + 5.4% (CI 3.6–7.1%; P < 0.05). Conclusion: In this first large-scale study that assesses IV APAP in shoulder arthroplasties, IV APAP use was not associated with decreased opioid utilization or the length/cost of stay. These results do not support routine use of IV APAP in this cohort, especially given its high cost. The translational potential for this article: Multimodal pain control to assist in reducing the opioid pain medications are seen as a route to improved postoperative patient outcomes, better pain control and expedited hospital discharge. Acetaminophen plays a significant role in these protocols in many institutions, but it is not established if this expensive IV formulation is superior to the oral formulation. This study evaluates the use and effectiveness of IV acetaminophen following shoulder arthroplasty at a large number of institutions. Keywords: Intravenous acetaminophen, Multimodal pain regimen, Opioid use, Postoperative pain control, Shoulder arthroplasty, Shoulder surgery |
| first_indexed | 2024-12-13T10:53:55Z |
| format | Article |
| id | doaj.art-ce126ae03ab446bea4ec2d6abe72416c |
| institution | Directory Open Access Journal |
| issn | 2214-031X |
| language | English |
| last_indexed | 2024-12-13T10:53:55Z |
| publishDate | 2019-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Orthopaedic Translation |
| spelling | doaj.art-ce126ae03ab446bea4ec2d6abe72416c2022-12-21T23:49:42ZengElsevierJournal of Orthopaedic Translation2214-031X2019-07-0118119127Effectiveness of intravenous acetaminophen for postoperative pain management in shoulder arthroplasties: A population-based studyDiana C. Patterson0Paul J. Cagle, Jr.1Jashvant Poeran2Nicole Zubizarreta3Madhu Mazumdar4Leesa M. Galatz5Shawn G. Anthony6Department of Orthopaedic Surgery, Mount Sinai Health System, New York, NY, USA; Corresponding author. Department of Orthopaedic Surgery, Mount Sinai Health System, 5 E 98th street, 9th floor, Box 1188, New York, NY 10029, USA.Department of Orthopaedic Surgery, Mount Sinai Health System, New York, NY, USAInstitute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USAInstitute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USAInstitute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USADepartment of Orthopaedic Surgery, Mount Sinai Health System, New York, NY, USADepartment of Orthopaedic Surgery, Mount Sinai Health System, New York, NY, USABackground: Intravenous acetaminophen (IV APAP) is an option in multimodal postoperative analgesia. Prior trials focus on hip and knee arthroplasties, whereas large-scale data on utilization and effectiveness in shoulder arthroplasties are lacking. Methods: Data on 67,494 (452 hospitals) partial/total shoulder arthroplasties were extracted from the Premier claims database (2011–2016). Patients were categorized by receipt and dosage of IV APAP. Multilevel models measured associations between IV APAP and opioid utilization (in oral morphine equivalents), length/cost of stay and opioid-related complications. Effect estimates (adjusted % change) with 95% confidence intervals (CIs) are reported. Results: IV APAP was used in 17.7% (n = 11,949) of patients with an increasing utilization trend. Most patients received only one dose on the day of surgery (69.5%; n = 8308). When adjusting for relevant covariates, IV APAP was not associated with meaningful effects on outcomes. Specifically, its use (versus no use) was not associated with decreased (but rather somewhat increased) opioid utilization: + 5.4% (CI 3.6–7.1%; P < 0.05). Conclusion: In this first large-scale study that assesses IV APAP in shoulder arthroplasties, IV APAP use was not associated with decreased opioid utilization or the length/cost of stay. These results do not support routine use of IV APAP in this cohort, especially given its high cost. The translational potential for this article: Multimodal pain control to assist in reducing the opioid pain medications are seen as a route to improved postoperative patient outcomes, better pain control and expedited hospital discharge. Acetaminophen plays a significant role in these protocols in many institutions, but it is not established if this expensive IV formulation is superior to the oral formulation. This study evaluates the use and effectiveness of IV acetaminophen following shoulder arthroplasty at a large number of institutions. Keywords: Intravenous acetaminophen, Multimodal pain regimen, Opioid use, Postoperative pain control, Shoulder arthroplasty, Shoulder surgeryhttp://www.sciencedirect.com/science/article/pii/S2214031X18300846 |
| spellingShingle | Diana C. Patterson Paul J. Cagle, Jr. Jashvant Poeran Nicole Zubizarreta Madhu Mazumdar Leesa M. Galatz Shawn G. Anthony Effectiveness of intravenous acetaminophen for postoperative pain management in shoulder arthroplasties: A population-based study Journal of Orthopaedic Translation |
| title | Effectiveness of intravenous acetaminophen for postoperative pain management in shoulder arthroplasties: A population-based study |
| title_full | Effectiveness of intravenous acetaminophen for postoperative pain management in shoulder arthroplasties: A population-based study |
| title_fullStr | Effectiveness of intravenous acetaminophen for postoperative pain management in shoulder arthroplasties: A population-based study |
| title_full_unstemmed | Effectiveness of intravenous acetaminophen for postoperative pain management in shoulder arthroplasties: A population-based study |
| title_short | Effectiveness of intravenous acetaminophen for postoperative pain management in shoulder arthroplasties: A population-based study |
| title_sort | effectiveness of intravenous acetaminophen for postoperative pain management in shoulder arthroplasties a population based study |
| url | http://www.sciencedirect.com/science/article/pii/S2214031X18300846 |
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