From the Plastic and Reconstructive Residency Program, Michigan State University College of Human Medicine Spectrum Health; the Departments of Anesthesiology and Plastic Surgery, The Ohio State University Wexner Medical Center; the Division of Colon and Rectal Surgery, Department of Surgery, Baylor University Medical Center; and the Department of Surgery, University of Tennessee Graduate School of Medicine.
Plast Reconstr Surg. 2019 Apr;143(4):1269-1274. doi: 10.1097/PRS.0000000000005435.
Postsurgical pain management is critical to patient satisfaction and value. Several studies have evaluated liposomal bupivacaine in postoperative pain management protocols; however, its economic feasibility remains undefined. This study analyzes the economic impact of liposomal bupivacaine using a national claims database to assess postoperative clinical and financial outcomes in plastic and reconstructive procedures.
The Vizient Clinical Data Base/Resource Manager electronic database was reviewed for plastic surgery procedures (i.e., abdominoplasty, abdominal wall reconstruction, mastectomy with immediate tissue expander placement, mastectomy with direct-to-implant reconstruction, autologous breast reconstruction, and augmentation mammaplasty) at participating hospitals from July 1, 2016, to July 1, 2017. The main outcome measures were the length of stay; 7-, 14-, and 30-day readmission rates; and direct and total costs observed.
During the study period, 958 total cases met inclusion criteria. Liposomal bupivacaine was used in 239 cases (25 percent). Compared with cases that did not use liposomal bupivacaine, liposomal bupivacaine cases had a decreased length of stay (9.2 days versus 5.8 days), decreased cost (total cost, $39,531 versus $28,021; direct cost, $23,960 versus $17,561), and lower 30-day readmission rates (4 percent versus 0 percent). The 14- and 7-day readmission rates were similar between the two groups.
The use of liposomal bupivacaine may contribute to a reduction in length of stay, hospital costs, and 30-day readmission rates for abdominal and breast reconstructive procedures, which could contribute to a favorable economic profile from a system view. Focusing on the measurement and improvement of value in the context of whole, definable, patient processes will be important as we transition to value-based payments.
术后疼痛管理对患者满意度和价值至关重要。多项研究已经评估了脂质体布比卡因在术后疼痛管理方案中的作用，但它的经济可行性尚不清楚。本研究使用国家索赔数据库分析脂质体布比卡因的经济影响，以评估整形和重建手术的术后临床和财务结果。
对参加医院 2016 年 7 月 1 日至 2017 年 7 月 1 日的整形手术（腹部整形术、腹壁重建术、即刻组织扩张器植入乳房切除术、直接植入物乳房重建术、自体乳房重建术和隆胸术）的 Vizient 临床数据库/资源管理器电子数据库进行了回顾。主要观察指标为住院时间；7 天、14 天和 30 天再入院率；以及观察到的直接和总费用。
在研究期间，958 例总病例符合纳入标准。239 例（25%）使用了脂质体布比卡因。与未使用脂质体布比卡因的病例相比，使用脂质体布比卡因的病例住院时间缩短（9.2 天对 5.8 天），成本降低（总费用 39531 美元对 28021 美元；直接费用 23960 美元对 17561 美元），30 天再入院率较低（4%对 0%）。两组 14 天和 7 天的再入院率相似。
在腹部和乳房重建手术中使用脂质体布比卡因可能有助于缩短住院时间、降低医院成本和 30 天再入院率，从系统角度来看，这可能有助于形成有利的经济状况。在向基于价值的支付过渡时，关注整个可定义的患者流程的价值衡量和改进将非常重要。
