Hansen Ryan N, Pham An T, Lovelace Belinda, Balaban Stela, Wan George J
1 University of Washington, Seattle, WA, USA.
2 Mallinckrodt Pharmaceuticals, Hampton, NJ, USA.
Ann Pharmacother. 2017 Oct;51(10):834-839. doi: 10.1177/1060028017715651. Epub 2017 Jun 13.
Recovery from obstetrics and gynecology (OB/GYN) surgery, including hysterectomy and cesarean section delivery, aims to restore function while minimizing hospital length of stay (LOS) and medical expenditures.
Our analyses compare OB/GYN surgery patients who received combination intravenous (IV) acetaminophen and IV opioid analgesia with those who received IV opioid-only analgesia and estimate differences in LOS, hospitalization costs, and opioid consumption.
We performed a retrospective analysis of the Premier Database between January 2009 and June 2015, comparing OB/GYN surgery patients who received postoperative pain management with combination IV acetaminophen and IV opioids with those who received only IV opioids starting on the day of surgery and continuing up to the second postoperative day. We performed instrumental variable 2-stage least-squares regressions controlling for patient and hospital covariates to compare the LOS, hospitalization costs, and daily opioid doses (morphine equivalent dose) of IV acetaminophen recipients with that of opioid-only analgesia patients.
We identified 225 142 OB/GYN surgery patients who were eligible for our study of whom 89 568 (40%) had been managed with IV acetaminophen and opioids. Participants averaged 36 years of age and were predominantly non-Hispanic Caucasians (60%). Multivariable regression models estimated statistically significant differences in hospitalization cost and opioid use with IV acetaminophen associated with $484.4 lower total hospitalization costs (95% CI = -$760.4 to -$208.4; P = 0.0006) and 8.2 mg lower daily opioid use (95% CI = -10.0 to -6.4), whereas the difference in LOS was not significant, at -0.09 days (95% CI = -0.19 to 0.01; P = 0.07).
Compared with IV opioid-only analgesia, managing post-OB/GYN surgery pain with the addition of IV acetaminophen is associated with decreased hospitalization costs and reduced opioid use.
妇产科（OB/GYN）手术的恢复，包括子宫切除术和剖宫产分娩，旨在恢复功能，同时尽量缩短住院时间（LOS）并降低医疗费用。
我们的分析比较了接受静脉注射（IV）对乙酰氨基酚和静脉注射阿片类药物联合镇痛的妇产科手术患者与仅接受静脉注射阿片类药物镇痛的患者，并估计住院时间、住院费用和阿片类药物消耗量的差异。
我们对2009年1月至2015年6月期间的Premier数据库进行了回顾性分析，比较了接受术后疼痛管理的妇产科手术患者，其中一组接受静脉注射对乙酰氨基酚和静脉注射阿片类药物联合治疗，另一组从手术当天开始仅接受静脉注射阿片类药物，并持续至术后第二天。我们进行了工具变量两阶段最小二乘回归，控制患者和医院协变量，以比较静脉注射对乙酰氨基酚接受者与仅接受阿片类药物镇痛患者的住院时间、住院费用和每日阿片类药物剂量（吗啡当量剂量）。
我们确定了225142名符合我们研究条件的妇产科手术患者，其中89568名（40%）接受了静脉注射对乙酰氨基酚和阿片类药物治疗。参与者平均年龄为36岁，主要是非西班牙裔白人（60%）。多变量回归模型估计，静脉注射对乙酰氨基酚与住院费用和阿片类药物使用存在统计学上的显著差异，总住院费用降低484.4美元（95%CI=-760.4至-208.4；P=0.0006），每日阿片类药物使用量降低8.2毫克（95%CI=-10.0至-6.4），而住院时间差异不显著，为-0.09天（95%CI=-0.19至0.01；P=0.07）。
与仅静脉注射阿片类药物镇痛相比，在妇产科手术后疼痛管理中添加静脉注射对乙酰氨基酚可降低住院费用并减少阿片类药物使用。
