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Improved Outcomes Associated With the Use of Intravenous Acetaminophen for Management of Acute Post-Surgical Pain in Cesarean Sections and Hysterectomies

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Title: Improved Outcomes Associated With the Use of Intravenous Acetaminophen for Management of Acute Post-Surgical Pain in Cesarean Sections and Hysterectomies
Authors: Urman, Richard, Boing, Elaine A., Pham, An T., Khangulov, Victor, Fain, Randi, Nathanson, Brian H., Zhang, Xuan, Wan, George J., Lovelace, Belinda, Cirillo, Jessica
Source: Urman, Richard D., Elaine A. Boing, An T. Pham, Victor Khangulov, Randi Fain, Brian H. Nathanson, Xuan Zhang, George J. Wan, Belinda Lovelace, and Jessica Cirillo. 2018. “Improved Outcomes Associated With the Use of Intravenous Acetaminophen for Management of Acute Post-Surgical Pain in Cesarean Sections and Hysterectomies.” Journal of Clinical Medicine Research 10 (6): 499-507. doi:10.14740/jocmr3380w. http://dx.doi.org/10.14740/jocmr3380w.
Publisher Information: Elmer Press, 2018.
Publication Year: 2018
Subject Terms: IV acetaminophen, Multimodal analgesia, Cesarean section, Hysterectomy, Opioid, Post-surgical pain, Acute pain, Health outcomes
More Details: Background: Post-surgical pain impacts many patient outcomes. Effective pain management increasingly relies on multimodal analgesia regimens in which acetaminophen (APAP) is a key component. The aim of our study was to examine the impact of oral APAP versus intravenous (IV) APAP as a component of post-surgical pain management after Cesarean sections and hysterectomies. Methods: A retrospective analysis of the Cerner HealthFacts® database (from January, 2011 to December, 2015) was conducted to compare outcomes of Cesarean section and hysterectomy surgery patients who received oral APAP to those who received IV APAP post-surgically. Length of stay (LOS), daily morphine milligram equivalent (MME) consumption, the presence of potential opioid-related adverse events (ORADEs), and total pharmacy costs were assessed. Adjusted results were derived using inverse probability weighted regression adjustment (IPW-RA) estimators based on covariates that included demographics, comorbidities, patient clinical characteristics, and hospital characteristics. Results: The study identified 29,124 Cesarean section patients (24,612 oral APAP; 4,512 IV APAP) and 9,767 hysterectomy surgery patients (5,586 oral APAP; 4,181 IV APAP). Compared to the oral APAP group, the IV APAP group had reductions in adjusted LOS (Cesarean section: -11.7% days (P < 0.001), hysterectomy: -11.8% days (P = 0.005)), lowered adjusted daily MME consumption from day 0 to day 3 (Cesarean section: -1.6 mg (P < 0.001), hysterectomy: -1.7 mg (P = 0.014)), and reduced risk of ORADEs for Cesarean sections (relative risk of 0.45, P < 0.001). Total pharmacy costs were not significantly different between the two APAP groups. Conclusions: Post-surgical pain managed with IV APAP in patients undergoing Cesarean section or hysterectomy was associated with shorter LOS, reduced risk of ORADEs, and lower opioid consumption compared to patients managed with oral APAP, without adversely impacting total pharmacy costs.
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Document Type: Journal Article
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Language: English
Relation: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5916539/pdf/; Journal of Clinical Medicine Research
DOI: 10.14740/jocmr3380w
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  Data: Urman, Richard D., Elaine A. Boing, An T. Pham, Victor Khangulov, Randi Fain, Brian H. Nathanson, Xuan Zhang, George J. Wan, Belinda Lovelace, and Jessica Cirillo. 2018. “Improved Outcomes Associated With the Use of Intravenous Acetaminophen for Management of Acute Post-Surgical Pain in Cesarean Sections and Hysterectomies.” Journal of Clinical Medicine Research 10 (6): 499-507. doi:10.14740/jocmr3380w. http://dx.doi.org/10.14740/jocmr3380w.
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  Data: &lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22IV+acetaminophen%22&quot;&gt;IV acetaminophen&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Multimodal+analgesia%22&quot;&gt;Multimodal analgesia&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Cesarean+section%22&quot;&gt;Cesarean section&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Hysterectomy%22&quot;&gt;Hysterectomy&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Opioid%22&quot;&gt;Opioid&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Post-surgical+pain%22&quot;&gt;Post-surgical pain&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Acute+pain%22&quot;&gt;Acute pain&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Health+outcomes%22&quot;&gt;Health outcomes&lt;/searchLink&gt;
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  Data: Background: Post-surgical pain impacts many patient outcomes. Effective pain management increasingly relies on multimodal analgesia regimens in which acetaminophen (APAP) is a key component. The aim of our study was to examine the impact of oral APAP versus intravenous (IV) APAP as a component of post-surgical pain management after Cesarean sections and hysterectomies. Methods: A retrospective analysis of the Cerner HealthFacts&#174; database (from January, 2011 to December, 2015) was conducted to compare outcomes of Cesarean section and hysterectomy surgery patients who received oral APAP to those who received IV APAP post-surgically. Length of stay (LOS), daily morphine milligram equivalent (MME) consumption, the presence of potential opioid-related adverse events (ORADEs), and total pharmacy costs were assessed. Adjusted results were derived using inverse probability weighted regression adjustment (IPW-RA) estimators based on covariates that included demographics, comorbidities, patient clinical characteristics, and hospital characteristics. Results: The study identified 29,124 Cesarean section patients (24,612 oral APAP; 4,512 IV APAP) and 9,767 hysterectomy surgery patients (5,586 oral APAP; 4,181 IV APAP). Compared to the oral APAP group, the IV APAP group had reductions in adjusted LOS (Cesarean section: -11.7% days (P &lt; 0.001), hysterectomy: -11.8% days (P = 0.005)), lowered adjusted daily MME consumption from day 0 to day 3 (Cesarean section: -1.6 mg (P &lt; 0.001), hysterectomy: -1.7 mg (P = 0.014)), and reduced risk of ORADEs for Cesarean sections (relative risk of 0.45, P &lt; 0.001). Total pharmacy costs were not significantly different between the two APAP groups. Conclusions: Post-surgical pain managed with IV APAP in patients undergoing Cesarean section or hysterectomy was associated with shorter LOS, reduced risk of ORADEs, and lower opioid consumption compared to patients managed with oral APAP, without adversely impacting total pharmacy costs.&lt;br /&gt;Version of Record
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