Deborah S Keller, MS, MD, Wissam Halabi, MD, Winston Chan, MD, Emily Saeler, MSN, RN, CRNI, James W Fleshman, MD, FACS, FASCRS, Walter Peters, MD, MBA, FACS, FASCRS. Baylor University Medical Center
Background: There is an opioid epidemic in the US, as pain medications given during the index stay serve as a gateway for chronic abuse. Efforts to reduce opioid use in surgery are paramount. The laparoscopic right hemicolectomy is one of the most common colorectal procedures performed, and a prime target for opioid-sparing pain management agents to improve outcomes. EXPAREL, a long-acting liposomal bupivacaine, is one tool that could help meet these needs by reducing opioid use, adverse events, and improving clinical recovery. Our goal was to look at the impact of EXPAREL in a national inpatient sample for patient and financial outcomes for a single procedure.
Methods: The Premier Perspectives Chargemaster Database was reviewed for patients undergoing laparoscopic right colectomy from 1/1/2011-9/31/2015. Patients were identified by ICD-9 primary procedure code(17.33), and stratified into EXPAREL(experimental) and control groups. Groups were 1:1 propensity-score matched on age, gender, comorbidity, region, payer, and hospital characteristics for comparability. The impact on perioperative and postoperative outcomes was evaluated. The main outcome measures were opioid use, opioid related adverse events(ORAE), length of stay(LOS) and total costs across groups.
Results: During the study period, 28,541 cases were identified; 8,805 at hospitals with EXPAREL available. Of these, 1,196(13.6%) were experimental and 7,603(86.4%) were controls. The experimental and control groups were well matched in patient and hospital demographics. After matching, there were 1,196 patients in each group. Operative times were comparable. The experimental group had significantly shorter PACU times(1.7 vs. 2.0 hours, p<0.001). Total opioid use for the hospital episode(459.0 vs. 482.4mg, p<0.001) and the rate of ORAE was significantly lower in the experimental group(5.5% vs. 8.4%, p=0.005). LOS was significantly shorter in the experimental than the control group(5.5 vs. 6.1 days, p<0.001). Despite the additional cost of the opioid-sparing agent, the total costs were slightly lower in the experimental group($14,834 vs. $14,952 respectively, p=NS). Postoperatively, readmissions at 60 and 90 days were significantly reduced in the experimental group(4.3% vs. 7.0%, p=0.004; 4.9% vs. 8.2%, respectively, p=0.001).
Conclusions: In a national sample, the single intervention of an opioid-sparing pain management agent was associated with a reduction in opioid use, complications, LOS, and readmissions. While total cost per patient was not significantly different, the cost savings over the population could be substantial with wider use of this agent. These results have implications for expanding use and controlled trials with this opioid-sparing pain management intervention to realize enhanced clinical and financial benefits.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79459
Program Number: P006
Presentation Session: Poster of Distinction (Non CME)
Presentation Type: PDIST
