Impact of treatment with liposomal bupivacaine on hospital costs, length of stay, and discharge status in patients undergoing total knee arthroplasty at high-use institutions

AbstractLiposomal bupivacaine is a novel method for pain control after total knee arthroplasty (TKA), but recent studies showed no advantage for patients undergoing TKA compared with traditional periarticular injection (PAI). The purpose of this analysis was to compare the clinical outcomes between liposomal bupivacaine treatment and traditional PAI. We retrospectively reviewed data from 16 clinical trials in published databases from their inception to June 2017. The primary outcome was postoperative Visual Analogue Scale (VAS) score and secondary outcomes included opiate usage, narcotic consumption, range of motion, and length of stay. Nine randomized controlled trials and seven nonrandomized controlled trials involving 924 liposomal bupivacaine cases and 1,293 traditional PAI cases were eligible for inclusion in the meta-analysis. No differences were detected in most of the clinical outcomes, except for postoperative VAS within 12 hours and length of stay. This analysis showed that liposomal bupivacaine is not associated with significant improvement in postoperative pain control or other outcomes in TKA compared with PAI.

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Comorbidities in Patients Undergoing Total Knee Arthroplasty: Do They Influence Hospital Costs and Length of Stay?

Clinical Orthopaedics and Related Research ◽

10.1007/s11999-014-3918-x ◽

2014 ◽

Vol 472 (12) ◽

pp. 3943-3950 ◽

Cited By ~ 59

Author(s):

Andrew J. Pugely ◽

Christopher T. Martin ◽

Yubo Gao ◽

Daniel A. Belatti ◽

John J. Callaghan

Keyword(s):

Total Knee Arthroplasty ◽

Length Of Stay ◽

Knee Arthroplasty ◽

Hospital Costs ◽

Total Knee

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Liposomal Bupivacaine Suspension Can Reduce Lengths of Stay and Improve Discharge Status of Patients Undergoing Total Knee Arthroplasty

The Journal of Knee Surgery ◽

10.1055/s-0036-1571431 ◽

2016 ◽

Vol 29 (03) ◽

pp. 224-227 ◽

Cited By ~ 9

Author(s):

Morad Chughtai ◽

Jeffrey Cherian ◽

Jaydev Mistry ◽

Randa Elmallah ◽

Alicia Bennett ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Liposomal Bupivacaine ◽

Lengths Of Stay ◽

Discharge Status ◽

Total Knee

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CORR Insights®: Comorbidities in Patients Undergoing Total Knee Arthroplasty: Do They Influence Hospital Costs and Length of Stay?

Clinical Orthopaedics and Related Research ◽

10.1007/s11999-014-3984-0 ◽

2014 ◽

Vol 472 (12) ◽

pp. 3951-3952

Author(s):

Michael L. Parks

Keyword(s):

Total Knee Arthroplasty ◽

Length Of Stay ◽

Knee Arthroplasty ◽

Hospital Costs ◽

Total Knee

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Does Addition of Adductor Canal Blockade to Multimodal Periarticular Analgesia Improve Discharge Status, Pain Levels, Opioid Use, and Length of Stay after Total Knee Arthroplasty?

The Journal of Knee Surgery ◽

10.1055/s-0037-1602131 ◽

2017 ◽

Vol 31 (02) ◽

pp. 184-188 ◽

Cited By ~ 8

Author(s):

Chukwuweike Gwam ◽

Jaydev Mistry ◽

Ifie Richards ◽

Dhrudeep Patel ◽

Nirav Patel ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Postoperative Pain ◽

Length Of Stay ◽

Knee Arthroplasty ◽

Opioid Consumption ◽

Categorical Variables ◽

Adductor Canal ◽

Significant Difference ◽

Discharge Status ◽

Total Knee

AbstractTotal knee arthroplasty (TKA) can be associated with substantial postoperative pain that may affect satisfaction and return to function. Various forms of pain control have been used; however, multimodal periarticular analgesia (MPA) and adductor canal block (ACB) have recently gained popularity. The purpose of this study was to compare (1) discharge status, (2) pain levels, (3) postoperative opioid consumption, and (4) length of stay (LOS) between TKA patients who received MPA only and those who received both MPA and ACB. A single surgeon database was reviewed for TKA patients who received MPA with or without ACB between January 2015 and April 2016. This yielded 110 patients who had a mean age of 62 years. Forty-five patients received MPA alone, while 65 patients received both modalities. Patient records were reviewed to obtain demographic and end-point data (discharge status, pain scores, opioid consumption, and LOS). Student's t-test and chi-squared test were used to compare continuous and categorical variables, respectively. There was no significant difference in discharge status (p = 0.304), pain levels (p = 0.343), and postoperative opioid consumption (p = 0.729) between the two cohorts. When compared with MPA patients, TKA patients who received both MPA and ACB demonstrated shorter LOS (2.44 vs. 1.98 days), a value that trended toward significance (p = 0.061). When comparing TKA patients who received MPA with those who received a combination of MPA and ACB, we were unable to elucidate a significant difference in any of the end points of interest. Therefore, MPA alone is comparable to combined MPA and ACB in managing postoperative pain in TKA patients. However, larger studies may be necessary to verify these findings.

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Trends in Periprosthetic Knee Infection and Associated Costs: A Population-Based Study Using National Data

The Journal of Knee Surgery ◽

10.1055/s-0040-1701516 ◽

2020 ◽

Author(s):

Robert Brochin ◽

Jashvant Poeran ◽

Khushdeep S. Vig ◽

Aakash Keswani ◽

Nicole Zubizarreta ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Length Of Stay ◽

Knee Arthroplasty ◽

Trend Test ◽

Strong Impact ◽

Hospitalization Costs ◽

Teaching Status ◽

Increasing Trend ◽

Total Knee ◽

Increasing Trends

AbstractGiven increasing demand for primary knee arthroplasties, revision surgery is also expected to increase, with periprosthetic joint infection (PJI) a main driver of costs. Recent data on national trends is lacking. We aimed to assess trends in PJI in total knee arthroplasty revisions and hospitalization costs. From the National Inpatient Sample (2003–2016), we extracted data on total knee arthroplasty revisions (n = 782,449). We assessed trends in PJI prevalence and (inflation-adjusted) hospitalization costs (total as well as per-day costs) for all revisions and stratified by hospital teaching status (rural/urban by teaching status), hospital bed size (≤299, 300–499, and ≥500 beds), and hospital region (Northeast, Midwest, South, and West). The Cochran–Armitage trend test (PJI prevalence) and linear regression determined significance of trends. PJI prevalence overall was 25.5% (n = 199,818) with a minor increasing trend: 25.3% (n = 7,828) in 2003 to 28.9% (n = 19,275) in 2016; p < 0.0001. Median total hospitalization costs for PJI decreased slightly ($23,247 in 2003–$20,273 in 2016; p < 0.0001) while median per-day costs slightly increased ($3,452 in 2003–$3,727 in 2016; p < 0.0001), likely as a function of decreasing length of stay. With small differences between hospitals, the lowest and highest PJI prevalences were seen in small (≤299 beds; 22.9%) and urban teaching hospitals (27.3%), respectively. In stratification analyses, an increasing trend in PJI prevalence was particularly seen in larger (≥500 beds) hospitals (24.4% in 2003–30.7% in 2016; p < 0.0001), while a decreasing trend was seen in small-sized hospitals. Overall, PJI in knee arthroplasty revisions appears to be slightly increasing. Moreover, increasing trends in large hospitals and decreasing trends in small-sized hospitals suggest a shift in patients from small to large volume hospitals. Decreasing trends in total costs, alongside increasing trends in per-day costs, suggest a strong impact of length of stay trends and a more efficient approach to PJI over the years (in terms of shorter length of stay).

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Total Hospital Costs and Readmission Rate of Patient-Specific Instrument in Total Knee Arthroplasty Patients

The Journal of Knee Surgery ◽

10.1055/s-0040-1713353 ◽

2020 ◽

Author(s):

Stephen Thomas ◽

Ankur Patel ◽

Corey Patrick ◽

Gary Delhougne

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Hospital Cost ◽

Readmission Rate ◽

Hospital Costs ◽

Patient Specific ◽

P Value ◽

Total Hospital Cost ◽

Total Hospital ◽

Total Knee

AbstractDespite advancements in surgical technique and component design, implant loosening, stiffness, and instability remain leading causes of total knee arthroplasty (TKA) failure. Patient-specific instruments (PSI) aid in surgical precision and in implant positioning and ultimately reduce readmissions and revisions in TKA. The objective of the study was to evaluate total hospital cost and readmission rate at 30, 60, 90, and 365 days in PSI-guided TKA patients. We retrospectively reviewed patients who underwent a primary TKA for osteoarthritis from the Premier Perspective Database between 2014 and 2017 Q2. TKA with PSI patients were identified using appropriate keywords from billing records and compared against patients without PSI. Patients were excluded if they were < 21 years of age; outpatient hospital discharges; evidence of revision TKA; bilateral TKA in same discharge or different discharges. 1:1 propensity score matching was used to control patients, hospital, and clinical characteristics. Generalized Estimating Equation model with appropriate distribution and link function were used to estimate hospital related cost while logistic regression models were used to estimate 30, 60, and 90 days and 1-year readmission rate. The study matched 3,358 TKAs with PSI with TKA without PSI patients. Mean total hospital costs were statistically significantly (p < 0.0001) lower for TKA with PSI ($14,910; 95% confidence interval [CI]: $14,735–$15,087) than TKA without PSI patients ($16,018; 95% CI: $15,826–$16,212). TKA with PSI patients were 31% (odds ratio [OR]: 0.69; 95% CI: 0.51–0.95; p-value = 0.0218) less likely to be readmitted at 30 days; 35% (OR: 0.65; 95% CI: 0.50–0.86; p-value = 0.0022) less likely to be readmitted at 60 days; 32% (OR: 0.68; 95% CI: 0.53–0.88; p-value = 0.0031) less likely to be readmitted at 90 days; 28% (OR: 0.72; 95% CI: 0.60–0.86; p-value = 0.0004) less likely to be readmitted at 365 days than TKA without PSI patients. Hospitals and health care professionals can use retrospective real-world data to make informed decisions on using PSI to reduce hospital cost and readmission rate, and improve outcomes in TKA patients.

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Increased Prevalence, Complications, and Costs of Smokers Undergoing Total Knee Arthroplasty

The Journal of Knee Surgery ◽

10.1055/s-0040-1713128 ◽

2020 ◽

Author(s):

Sean S. Rajaee ◽

Eytan M. Debbi ◽

Guy D. Paiement ◽

Andrew I. Spitzer

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Smoking Status ◽

Hospital Costs ◽

Patient Characteristics ◽

The United States ◽

Bundled Payment ◽

Vein Thrombosis ◽

Total Knee ◽

Payment Models

AbstractGiven a national push toward bundled payment models, the purpose of this study was to examine the prevalence as well as the effect of smoking on early inpatient complications and cost following elective total knee arthroplasty (TKA) in the United States across multiple years. Using the nationwide inpatient sample, all primary elective TKA admissions were identified from 2012 to 2014. Patients were stratified by smoking status through a secondary diagnosis of “tobacco use disorder.” Patient characteristics as well as prevalence, costs, and incidence of complications were compared. There was a significant increase in the rate of smoking in TKA from 17.9% in 2012 to 19.2% in 2014 (p < 0.0001). The highest rate was seen in patients < 45 years of age (27.3%). Hospital resource usage was significantly higher for smokers, with a length of stay of 3.3 versus 2.9 days (p < 0.0001), and hospital costs of $16,752 versus $15,653 (p < 0.0001). A multivariable logistic model adjusting for age, gender, and comorbidities showed that smokers had an increased odds ratio for myocardial infarction (5.72), cardiac arrest (4.59), stroke (4.42), inpatient mortality (4.21), pneumonia (4.01), acute renal failure (2.95), deep vein thrombosis (2.74), urinary tract infection (2.43), transfusion (1.38) and sepsis (0.65) (all p < 0.0001). Smoking is common among patients undergoing elective TKA, and its prevalence continues to rise. Smoking is associated with higher hospital costs as well as higher rates of immediate inpatient complications. These findings are critical for risk stratification, improving of bundled payment models as well as patient education, and optimization prior to surgery to reduce costs and complications.

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Intravenous patient-controlled analgesia vs nurse administered oral oxycodone after total knee arthroplasty: a retrospective cohort study

Scandinavian Journal of Pain ◽

10.1515/sjpain-2020-0012 ◽

2020 ◽

Vol 0 (0) ◽

Author(s):

Katarina Lahtinen ◽

Elina Reponen ◽

Anne Vakkuri ◽

Riku Palanne ◽

Mikko Rantasalo ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Length Of Stay ◽

Knee Arthroplasty ◽

Pain Medication ◽

Secondary Outcome ◽

Control Group ◽

Patient Controlled Analgesia ◽

Total Knee Arthroplasty Patient ◽

Opioid Dose ◽

Total Knee

AbstractShort CommunicationsSevere post-operative pain is common after total knee arthroplasty. Patient-controlled analgesia is an alternative method of pain management, whereby a patient administers his or her own pain medication. Patients seem to prefer this method over nurse-administered analgesia. However, it remains unclear whether patients using patient-controlled analgesia devices use higher or lower doses of opioids compared to patients treated with oral opioids.Objectives and MethodsThis retrospective study examined 164 patients undergoing total knee arthroplasty. Post-operatively, 82 patients received oxycodone via intravenous patient-controlled analgesia devices, while the pain medication for 82 patients in the control group was administered by nurses. The main outcome measure was the consumption of intravenous opioid equivalents within 24 h after surgery. Secondary outcome measures were the use of anti-emetic drugs and the length of stay. Furthermore, we evaluated opioid-related adverse event reports.ResultsThe consumption of opioids during the first 24 h after surgery and the use of anti-emetic drugs were similar in both groups. The median opioid dose of intravenous morphine equivalents was 41.1 mg (interquartile range (IQR): 29.5–69.1 mg) in the patient-controlled analgesia group and 40.5 mg (IQR: 32.4–48.6 mg) in the control group, respectively. The median length of stay was 2 days (IQR: 2–3 days) in the patient-controlled analgesia group and 3 days (IQR: 2–3 days) in the control group (p=0.02). The use of anti-emetic drugs was similar in both groups.ConclusionsThe administration of oxycodone via intravenous patient-controlled analgesia devices does not lead to increased opioid or anti-emetic consumptions compared to nurse-administered pain medication after total knee arthroplasty. Patient-controlled analgesia might lead to shortened length of stay.

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