Cherian Jeffrey J, Barrington John, Elmallah Randa K, Chughtai Morad, Mistry Jaydev B, Mont Michael A
Orthopaedic Surgery Department, Philadelphia College of Osteopathic Medicine, Philadelphia, PA.
The Joint Replacement Center, Baylor Medical Center of Frisco, Plano, TX.
Surg Technol Int. 2015 Nov;27:235-9.
To ensure good rehabilitation and improved outcomes following total hip arthroplasty (THA), optimal pain control is necessary. Newer methods of pain control have been advocated, as current modalities have been associated with undesirable side effects and serious complications. One such modality is liposomal bupivacaine, which provides long-acting, slow-release analgesia. The purpose of this study was to evaluate: (1) lengths of hospital stay and (2) the discharge status of patients who underwent THA with liposomal bupivacaine compared to a cohort who received standard analgesic regimens.
We utilized a hospital discharge database from July 1, 2013 to June 30, 2014, which included 7,704,919 patients for our analysis. We selected patients aged 18 years or older who had an inpatient stay for THA using ICD-9 procedure code (ICD-9-CM = 81.51), which resulted in 55,129 THA patients. Patients who had a nerve block in the time period from the surgery date to the discharge date were then excluded, which resulted in 54,604 THA patients. The THA cohort who received liposomal bupivacaine suspension consisted of 5,267 patients (2,907 women; 2,360 men) who had a mean age of 64 years, while the THA without injections or nerve block consisted of 49,337 patients who had a mean age of 65 years that consisted of 27,530 women and 21,807 men. We analyzed length-of-stay by controlling for race, region, age, sex, Charlson Index, and operating time using a log link linear model with a negative binomial distribution. The discharge status to home compared to short-term nursing facility or rehabilitation was analyzed using logistic regression while controlling for the aforementioned covariates.
The mean lengths of stay, after adjusting for covariates, for the liposomal bupivacaine cohort was significantly shorter than the no injection cohort. The distribution of patients being discharged to home compared to a short-term nursing facility or a rehabilitation facility was higher in the liposomal bupivacaine cohort compared to the cohort who did not receive liposomal bupivacaine. Multivariate logistic regression analyses demonstrated a higher likelihood of being discharged to home in liposomal bupivacaine cohort when compared to no injection.
Liposomal bupivacaine appears to be an effective pain relief modality that leads to reduced lengths of hospital stay and increased rates of discharge to home. This may be an appropriate addition for the analgesic armamentarium in patients who undergo THA.
为确保全髋关节置换术（THA）后良好的康复效果及改善预后，进行最佳的疼痛控制很有必要。由于目前的疼痛控制方式存在不良副作用和严重并发症，因此有人提倡采用更新的方法。脂质体布比卡因就是这样一种方式，它能提供长效、缓释镇痛。本研究的目的是评估：（1）住院时间；（2）与接受标准镇痛方案的队列相比，接受脂质体布比卡因进行THA手术患者的出院状态。
我们使用了2013年7月1日至2014年6月30日的医院出院数据库，其中包括7,704,919例患者用于分析。我们选择年龄在18岁及以上、使用ICD - 9手术编码（ICD - 9 - CM = 81.51）进行THA住院治疗的患者，最终得到55,129例THA患者。然后排除在手术日期至出院日期期间接受神经阻滞的患者，最终得到54,604例THA患者。接受脂质体布比卡因混悬液的THA队列由5,267例患者（2,907名女性；2,360名男性）组成，平均年龄为64岁，而未接受注射或神经阻滞的THA队列由49,337例患者组成，平均年龄为65岁，其中包括27,530名女性和21,807名男性。我们使用具有负二项分布的对数链接线性模型，通过控制种族、地区、年龄、性别、查尔森指数和手术时间来分析住院时间。使用逻辑回归分析在控制上述协变量的情况下，与短期护理机构或康复机构相比回家的出院状态。
在调整协变量后，脂质体布比卡因队列的平均住院时间明显短于未注射队列。与未接受脂质体布比卡因的队列相比，脂质体布比卡因队列中回家而非短期护理机构或康复机构的患者分布更高。多变量逻辑回归分析表明，与未注射相比，脂质体布比卡因队列回家的可能性更高。
脂质体布比卡因似乎是一种有效的疼痛缓解方式，可缩短住院时间并提高回家的出院率。这可能是接受THA手术患者镇痛手段中的一种合适补充。
