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A Randomized, Double-Blind, Placebo-Controlled Trial of Intravenous Acetaminophen on Hospital Length of Stay in Obese Individuals Undergoing Sleeve Gastrectomy

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Abstract

Background

Retrospective studies indicate that acetaminophen iv administration reduces hospital length of stay (LoS) and opiate consumption in patients undergoing bariatric surgery.

Objective

This study sought to determine whether using acetaminophen iv in morbidly obese subjects undergoing sleeve gastrectomy decreased LoS and total hospital charges as compared to patients receiving saline placebo.

Setting

Single-center university hospital

Methods

Using a randomized, double-blind, placebo-controlled design, subjects were assigned to receive either acetaminophen iv (group A) or saline placebo iv (group P). Data were collected between Jan 1 and Dec 31, 2016. Group A received acetaminophen every 6 h for a total of four doses. The first dose was administered following the induction of general anesthesia; group P received saline iv on the same schedule. Anesthetic management and prophylactic antiemetic regimen were standardized in all subjects. Postoperative pain management consisted of hydromorphone via patient-controlled infusion pump. Primary outcomes include hospital LoS and associated hospital costs. Secondary outcomes include patient satisfaction and postoperative nausea and pain scores.

Results

Subject demographics (n = 127) and intraoperative management were similar in the two groups. Across all subjects, median hospital LoS in group A (n = 63) was 1.87 vs. 1.97 days in group P (n = 64) (p = 0.03, Wilcoxon rank-sum test). Postoperatively, daily quality-of-recovery (QoR-15) scores, narcotic consumption, and the use of rescue antiemetics were not significantly different between groups. Median hospital costs were as follows: group A, $12,885 vs. group P, $12,977 (n = 64).

Conclusions

Acetaminophen iv may reduce hospital LoS in subjects undergoing sleeve gastrectomy.

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Acknowledgements

This work would not have been possible without the excellent collaboration between the Departments of Anesthesiology and Surgery. The authors wish to expressly thank the many faculty, residents, nurse anesthetists, and research aides in both the Department of Anesthesiology and Surgery for their cooperation and assistance during the course of this study. We also wish to thank Paul Christos, Dr. P.H, M.S., for constructive comments and suggestions on the manuscript.

Funding

This work was funded by Mallinckrodt Pharmaceuticals. Ms. Xian Wu, MPH, was partially supported by the following grant: Clinical and Translational Science Center at Weill Cornell Medical College (UL1-TR000457-06).

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Authors and Affiliations

  1. Department of Anesthesiology, Weill Cornell Medical College, 1300 York Avenue, Room A-1050, New York, NY, 10065, USA

    Farrell E. Cooke, Jon D. Samuels, Farida Gadalla & Peter A. Goldstein

  2. Department of Surgery, Weill Cornell Medical College, New York, NY, USA

    Alfons Pomp, Cheguevara Afaneh & Gregory F. Dakin

  3. Department of Healthcare Policy and Research (Division of Biostatistics and Epidemiology), Weill Cornell Medical College, New York, NY, USA

    Xian Wu

  4. Department of Medicine, Weill Cornell Medical College, New York, NY, USA

    Peter A. Goldstein

Authors
  1. Farrell E. Cooke
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  2. Jon D. Samuels
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  3. Alfons Pomp
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  4. Farida Gadalla
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  5. Xian Wu
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  6. Cheguevara Afaneh
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  7. Gregory F. Dakin
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  8. Peter A. Goldstein
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Contributions

Study concept/design (JDS, AP, PAG), data acquisition (FEC, JDS, AP, FG, CA, GFD, PAG), data analysis (FEC, XW, PAG), interpretation of data (FEC, AP, FG, XW, CA, PAG), manuscript preparation (FEC, PAG), manuscript revision/editing (FEC, JDS, AP, FG, XW, CA, GFD, PAG), approval of submitted manuscript (FEC, JDS, AP, FG, XW, CA, GFD, PAG), agreement to be accountable for all aspects of the work (FEC, JDS, AP, FG, XW, CA, GFD, PAG).

Corresponding author

Correspondence to Peter A. Goldstein.

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Conflict of Interest

FEC, JDS, FG, XW, CA, and GFD have no conflicts to declare. AP has served as a speaker for Medtronic, Ethicon, and W.L. Gore & Associates and has received honoraria from those companies. PAG receives additional research support from the United States Department of Defense and the Tri-Institutional Stem Cell Initiative for basic science research in areas unrelated to the work presented here.

Appendix. Quality of Recovery-15 Survey

Appendix. Quality of Recovery-15 Survey

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Cooke, F.E., Samuels, J.D., Pomp, A. et al. A Randomized, Double-Blind, Placebo-Controlled Trial of Intravenous Acetaminophen on Hospital Length of Stay in Obese Individuals Undergoing Sleeve Gastrectomy. OBES SURG 28, 2998–3006 (2018). https://doi.org/10.1007/s11695-018-3316-7

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