a University of Washington , School of Pharmacy , Seattle , WA , USA.
b University of California San Francisco , School of Pharmacy , San Francisco , CA , USA.
Curr Med Res Opin. 2018 Sep;34(9):1549-1555. doi: 10.1080/03007995.2017.1412301. Epub 2018 Jan 4.
To evaluate intravenous (IV) acetaminophen (APAP) vs oral APAP use as adjunctive analgesics in cholecystectomy patients by comparing associated hospital length of stay (LOS), hospital costs, opioid use, and rates of nausea/vomiting, respiratory depression, and bowel obstruction.
We conducted a retrospective analysis of the Premier Database (January 2012 to September 2015) including cholecystectomy patients who received either IV APAP or oral APAP. Differences in LOS, hospitalization costs, mean daily morphine equivalent dose (MED), and potential opioid-related adverse events were estimated. Multivariable logistic regression was performed for the binary 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 continuous outcomes. Models were adjusted for patient demographics, clinical risk factors, and hospital characteristics.
Among 61,017 cholecystectomy patients, 31,133 (51%) received IV APAP. Subjects averaged 51 and 57 years of age, respectively, in the IV and oral APAP cohorts. In the adjusted models, IV APAP was associated with 0.42 days shorter LOS (95% CI = -0.58 to -0.27; p < .0001), $1,045 lower hospitalization costs (95% CI = -$1,521 to -$569; p < .0001), 2 mg lower average daily MED (95% CI = -3 mg to -0.9 mg; p = .0005), and lower rates of respiratory depression (odds ratio [OR] = 0.89, 95% CI = 0.82-0.97; p = .006), and nausea and vomiting (OR = 0.86, 95% CI = 0.86-0.86; p < .0001).
In patients having cholecystectomy, the addition of IV APAP to perioperative pain management is associated with shorter LOS, lower costs, reduced opioid use, and less frequent nausea/vomiting and respiratory depression compared to oral APAP. These findings should be confirmed in a prospective study comparing IV and oral APAP.
通过比较胆囊切除术患者静脉（IV）用对乙酰氨基酚（APAP）与口服 APAP 作为辅助镇痛药物，评估 IV 用 APAP 的使用情况，比较相关的住院时间（LOS）、住院费用、阿片类药物使用情况以及恶心/呕吐、呼吸抑制和肠梗阻的发生率。
我们对 Premier 数据库（2012 年 1 月至 2015 年 9 月）进行了回顾性分析，纳入接受 IV APAP 或口服 APAP 的胆囊切除术患者。估计 LOS、住院费用、平均每日吗啡等效剂量（MED）以及潜在的阿片类药物相关不良事件的差异。二项结局采用多变量逻辑回归，连续结局采用工具变量回归（两阶段最小二乘法回归），使用医院内所有住院患者的 IV APAP 使用季度率作为工具。模型调整了患者人口统计学、临床危险因素和医院特征。
在 61017 例胆囊切除术患者中，31133 例（51%）接受了 IV APAP。在 IV 和口服 APAP 队列中，患者的平均年龄分别为 51 岁和 57 岁。在调整后的模型中，IV APAP 与 LOS 缩短 0.42 天（95%CI=-0.58 至-0.27；p<0.0001）、住院费用降低 1045 美元（95%CI=-1521 美元至-569 美元；p<0.0001）、平均每日 MED 降低 2 毫克（95%CI=-3 毫克至-0.9 毫克；p=0.0005）以及呼吸抑制（比值比[OR]）降低有关=0.89，95%CI=0.82-0.97；p=0.006）和恶心呕吐（OR=0.86，95%CI=0.86-0.86；p<0.0001）的发生率较低。
在接受胆囊切除术的患者中，与口服 APAP 相比，围手术期疼痛管理中添加 IV APAP 与 LOS 缩短、成本降低、阿片类药物使用减少以及恶心/呕吐和呼吸抑制的发生率降低相关。这些发现应在比较 IV 和口服 APAP 的前瞻性研究中得到证实。
