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首页> 外文期刊>Current medical research and opinion >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
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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

机译：术后疼痛管理术后疼痛患者的住院时间，住院成本，阿片类药物和排放状态的比较分析，包括静脉内与口服乙酰氨基酚

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Background: Recovery from spine surgery is oriented toward restoring functional health outcomes while reducing resource use. Optimal pain management is a key to reaching these objectives. We compared outcomes of spine surgery patients who received standard pain management including intravenous (IV) acetaminophen (APAP) vs. oral APAP.Methods: We performed a retrospective analysis of the Premier database (January 2012 to September 2015) comparing spine surgery patients who received pain management with IV APAP to those who received oral APAP, with no exclusions based on additional pain management. We performed multivariable logistic regression for the discharge and all cause 30-day readmission to the same hospital outcomes and instrumental variable regressions using the quarterly rate of IV APAP use for all hospitalizations by hospital as the instrument in two-stage least squares regressions for length of stay (LOS), hospitalization costs, and average daily morphine equivalent dose (MED) outcomes. Models adjusted for age, gender, race, admission type, 3M All Patient Refined Diagnosis Related Group severity of illness and risk of mortality, hospital size, and indicators for whether the hospital was an academic center and whether it was urban or rural.Results: We identified 112,586 spine surgery patients with 51,835 (46%) having received IV APAP. Subjects averaged 57 and 59 years of age respectively in the IV APAP and oral APAP cohorts and were predominantly non-Hispanic Caucasians and female. In our adjusted models, IV APAP was associated with 0.68 days shorter LOS (95% CI: -0.76 to -0.59, p<.0001), $1175 lower hospitalization costs (95% CI: -$1611 to -$739, p<.0001), 13mg lower average daily MED (95% CI: -14mg to -12mg, p<.0001), 34% lower risk of discharge to a skilled nursing facility (95% CI: 0.63 to 0.69, p<.0001), and 13% less risk of 30-day readmission (95% CI: 0.73 to 1.03).Conclusions: Compared to oral APAP, managing post-spine-surgery pain with IV APAP is associated with less resource use, lower costs, lower doses of opioids, and improved discharge status.
机译：背景：从脊柱手术中恢复以减少资源使用的同时恢复功能健康结果。最佳疼痛管理是达到这些目标的关键。我们比较了接受标准疼痛管理的脊柱手术患者的结果，包括静脉注射（IV）乙酰氨基酚（APAP）与口头APAP.Methods对IV APAP的疼痛管理对那些接受口头APAP的人，没有基于额外痛苦管理的排除。我们对卸货进行了多变量的逻辑回归，所有导致30天的读入与医院所有住院的季度率和仪器变量回归使用医院的所有住院率作为两个阶段最小二乘的仪器的长度保持（LOS），住院费用和平均每日吗啡同等剂量（MED）结果。适用于年龄，性别，种族，入学型，3M的模型，所有患者精致诊断相关组的疾病严重程度和死亡率，医院规模和指标的风险，以及医院是否是学术中心，是否是城市或乡村。结果：我们鉴定了112,586名脊柱手术患者，患有51,835（46％）的患者获得了IV APAP。 IV APAP和口头APAP队列中分别在57和59岁的受试者平均为57和59岁，主要是非西班牙裔人和女性。在我们的调整模型中，IV APAP与0.68天较短的LOS（95％CI：-0.76至-0.59，P <.0001），1175美元的住院费用（95％CI： - $ 1611至739美元，P <.0001 ），13毫克下平均每日MED（95％CI：-14mg至-12mg，P <.0001），降低熟练护理设施的风险降低34％（95％CI：0.63至0.69，P <.0001）， 30天即将入院风险减少13％（95％CI：0.73至1.03）。与口腔APAP相比，使用IV APAP管理脊柱手术疼痛与较少的资源使用，降低成本，降低剂量相关联阿片类药物，提高放电状态。

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