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IV Acetaminophen Results in Lower Hospital Costs and Emergency Room Visits Following Bariatric Surgery: a Double-Blind, Prospective, Randomized Trial in a Single Accredited Bariatric Center

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Postoperative pain control in bariatric surgery is challenging, despite use of intravenous (IV) narcotics. IV acetaminophen is one pain control alternative.

Objective

The aim of this study was to investigate the economic impact of IV acetaminophen in bariatric surgery and its effect on patients’ pain, satisfaction, and hospital length of stay.

Methods

In a randomized controlled trial, Group 1 (treatment) received IV acetaminophen plus IV narcotics 30 min before surgery, then medication plus IV narcotics/PO narcotics for the remaining 18 h. Group 2 (control) received IV normal saline plus IV/PO narcotics. Patients underwent laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (SG). Primary outcomes included direct hospital costs, length of stay, postoperative pain, and patient satisfaction. Secondary outcomes included indirect costs, rescue narcotics dosage, and 30-day outcomes.

Results

Mean direct hospital cost in the treatment group (n = 50) was $3089.18 versus $2991.62 for the control group (n = 50) (p > 0.05). Pain scores did not differ significantly (p = 0.61). After adjusting for surgery type, there was no significant difference in length of stay (p = 0.95). Significantly more control group patients incurred surgery-related indirect costs (10 versus 2 %, p < 0.05), with greater presentation to the emergency department (ED) for abdominal pain (5/50 versus 1/50), yielding higher total indirect costs ($39,293 versus $13,185).

Conclusions

Using IV acetaminophen for postoperative pain management produced notable indirect cost savings and reduced ED visits in the first 30 days postoperatively, with good safety and tolerance. Decreased statistical power may have accounted for certain non-significant findings.

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References

  1. Buchwald H, Williams SE. Bariatric surgery worldwide 2003. Obes Surg 2004;14:1157–64.

    Article  PubMed  Google Scholar 

  2. Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA 2004;292:1724–37.

    Article  CAS  PubMed  Google Scholar 

  3. Mingrone G, Panunzi S, De Gaetano A, Guidone C, Iaconelli A, Leccesi L, et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med 2012;366:1577–85.

    Article  CAS  PubMed  Google Scholar 

  4. Schauer PR, Kashyap SR, Wolski K, Brethauer SA, Kirwan JP, Pothier CE, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med 2012;366:1567–76.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. DeMaria EJ, Winegar DA, Pate VW, Hutcher NE, Ponce J, Pories WJ. Early postoperative outcomes of metabolic surgery to treat diabetes from sites participating in the ASMBS Bariatric Surgery Center of Excellence program as reported in the Bariatric Outcomes Longitudinal Database. Transactions of the Meeting of the American Surgical Association 2010;128:166–75.

    Article  Google Scholar 

  6. Gould JC, Kent KC, Wan Y, Rajamanickam V, Leverson G, Campos GM. Perioperative safety and volume: outcomes relationships in bariatric surgery: a study of 32,000 patients. J Am Coll Surg 2011;213:771–7.

    Article  PubMed  Google Scholar 

  7. Jafari MD, Jafari F, Young MT, Smith BR, Phalen MJ, Nguyen NT. Volume and outcome relationship in bariatric surgery in the laparoscopic era. Surg Endosc 2013;27:4539–46.

    Article  PubMed  Google Scholar 

  8. Hutter MM, Schirmer BD, Jones DB, Ko CY, Cohen ME, Merkow RP, et al. First report from the American College of Surgeons Bariatric Surgery Center Network. Annals of Surgery 2011;254:410–22.

    Article  PubMed  PubMed Central  Google Scholar 

  9. DeMaria EJ, Pate V, Warthen M, Winegar DA. Baseline data from American Society for Metabolic and Bariatric Surgery-designated Bariatric Surgery Centers of Excellence using the Bariatric Outcomes Longitudinal Database. Surg Obes Relat Dis 2014;6:347–55.

    Article  Google Scholar 

  10. Chaar El M, Claros L, Ezeji GC, Miletics M, Stoltzfus J. Improving outcome of bariatric surgery: best practices in an accredited surgical center. Obes Surg 2014;24:1057–63.

    PubMed  Google Scholar 

  11. Wininger SJ, Miller H, Minkowitz HS, Royal MA, Ang RY, Breitmeyer JB, et al. A randomized, double-blind, placebo-controlled, multicenter, repeat-dose study of two intravenous acetaminophen dosing regimens for the treatment of pain after abdominal laparoscopic surgery. Clinical Therapeutics 2010;32:2348–69.

    Article  CAS  PubMed  Google Scholar 

  12. Frank Peacock W, Breitmeyer JB, Pan C, Smith WB, Royal MA. A randomized study of the efficacy and safety of intravenous acetaminophen compared to oral acetaminophen for the treatment of fever. Acad Emerg Med 2011;18:360–6.

    Article  PubMed  Google Scholar 

  13. Juhl GI, Norholt SE, Tonnesen E, Hiesse-Provost O, Jensen TS. Analgesic efficacy and safety of intravenous paracetamol (acetaminophen) administered as a 2 g starting dose following third molar surgery. European Journal of Pain 2012;10:371–1.

    Article  Google Scholar 

  14. Moller PL, Juhl GI, Payen-Champenois C, Skoglund LA. Intravenous acetaminophen (paracetamol): comparable analgesic efficacy, but better local Safety than its prodrug, propacetamol, for postoperative pain after third molar surgery. Anesthesia & Analgesia 2005;101:90–6.

    Article  CAS  Google Scholar 

  15. Buchwald H, Estok R, Fahrbach K, Banel D, Sledge I. Trends in mortality in bariatric surgery: A systematic review and meta-analysis. Surgery 2007;142:621–35.

    Article  PubMed  Google Scholar 

  16. Carlsson LMS, Peltonen M, Ahlin S, Anveden Å, Bouchard C, Carlsson B, et al. Bariatric surgery and prevention of type 2 diabetes in swedish obese subjects. N Engl J Med 2012;367:695–704.

    Article  CAS  PubMed  Google Scholar 

  17. Salem L, Devlin A, Sullivan SD, Flum DR. Cost-effectiveness analysis of laparoscopic gastric bypass, adjustable gastric banding, and nonoperative weight loss interventions. Surg Obes Relat Dis 2008;4:26–32.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Clegg A, Colquitt J, Sidhu M, Royle P, Walker A. Clinical and cost effectiveness of surgery for morbid obesity: a systematic review and economic evaluation. Int J Obes Relat Metab Disord 2003;27:1167–77.

    Article  CAS  PubMed  Google Scholar 

  19. Weiner JP, Goodwin SM, Chang H-Y, Bolen SD, Richards TM, Johns RA, et al. Impact of bariatric surgery on health care costs of obese persons. JAMA Surg 2013;148:555.

    Article  PubMed  Google Scholar 

  20. Gouvas N, Tan E, Windsor A, Xynos E, Tekkis PP. Fast-track versus standard care in colorectal surgery: a meta-analysis update. Int J Colorectal Dis 2009;24:1119–31.

    Article  PubMed  Google Scholar 

  21. Carli F, Charlebois P, Baldini G, Cachero O, Stein B. Une approche pluridisciplinaire intégrée visant la mise en œuvre d’un programme accéléré pour la chirurgie colorectale par laparoscopie. Can J Anesth/J Can Anesth 2009;56:837–42.

    Article  Google Scholar 

  22. Counihan T, Favuzza J. Fast track colorectal surgery. Clinics in Colon and Rectal Surgery 2009;22:060–72.

    Article  Google Scholar 

  23. Burns EM, Naseem H, Bottle A, Lazzarino AI, Aylin P, Darzi A, et al. Introduction of laparoscopic bariatric surgery in England: observational population cohort study. BMJ 2010;341:c4296–6.

    Article  PubMed  Google Scholar 

  24. Kellogg TA, Swan T, Leslie DA, Buchwald H, Ikramuddin S. Patterns of readmission and reoperation within 90 days after Roux-en-Y gastric bypass. Surg Obes Relat Dis 2009;5:416–24.

    Article  PubMed  Google Scholar 

  25. Nguyen NT, Slone JA, Nguyen X-MT, Hartman JS, Hoyt DB. A prospective randomized trial of laparoscopic gastric bypass versus laparoscopic adjustable gastric banding for the treatment of morbid obesity. transactions of the Meeting of the American Surgical Association 2009;127:262–72.

    Article  Google Scholar 

  26. Flum DR, Belle SH, King WC, Wahed AS, Berk P, Chapman W, et al. Perioperative safety in the longitudinal assessment of bariatric surgery. N Engl J Med 2009;361:445–54.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Medical School of Temple University/St. Luke’s University Health Network, 240 Cetronia Road, Suite 205, North Allentown, PA, 18104, USA

    Maher El Chaar, Jill Stoltzfus, Leonardo Claros & Tara Wasylik

Authors
  1. Maher El Chaar
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  2. Jill Stoltzfus
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  3. Leonardo Claros
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  4. Tara Wasylik
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Corresponding author

Correspondence to Maher El Chaar.

Ethics declarations

All procedures performed with human participants in this study were in accordance with the ethical standards of the SLUHN Institutional Review Board (IRB) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of Interest

Dr. El Chaar, Dr. Stoltzfus, and Ms. Wasylik received study funding from Cadence Pharmaceuticals (now a part of Mallinckrodt Pharmaceuticals), including fees for Principal Investigator costs (Dr. El Chaar), statistician services (Dr. Stoltzfus), and research coordinator services (Ms. Wasylik). Dr. Claros did not receive any funding to conduct this study.

Informed Consent

Informed consent was obtained from all individual participants included in the study. Since identifying information from individual participants was not obtained as part of this study, no additional informed consent was required.

Additional information

Funding provided by Cadence Pharmaceuticals (now a part of Mallinckrodt Pharmaceuticals)

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El Chaar, M., Stoltzfus, J., Claros, L. et al. IV Acetaminophen Results in Lower Hospital Costs and Emergency Room Visits Following Bariatric Surgery: a Double-Blind, Prospective, Randomized Trial in a Single Accredited Bariatric Center. J Gastrointest Surg 20, 715–724 (2016). https://doi.org/10.1007/s11605-016-3088-0

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  • DOI: https://doi.org/10.1007/s11605-016-3088-0

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