Holtz Margaret, Liao Nick, Lin Jennifer H, Asche Carl V
Georgia Anesthesiologists LLC, Marietta, Georgia.
Pacira Biosciences, Inc, Parsippany, New Jersey.
J Health Econ Outcomes Res. 2022 Sep 14;9(2):86-94. doi: 10.36469/001c.37739. eCollection 2022.
Epidural analgesia can be associated with high costs and postsurgical risks such as hypotension, despite its widespread use and value in providing opioid-sparing pain management. We tested the hypothesis that liposomal bupivacaine (LB) might be a reliable alternative to epidural analgesia in this real-world study. To compare economic outcomes and hypotension incidence associated with use of LB and epidural analgesia for abdominal surgery. This retrospective analysis identified records of adults who underwent abdominal surgeries between January 2016 and September 2019 with either LB administration or traditional epidural analgesia using the Premier Healthcare Database. Economic outcomes included length of stay, hospital costs, rates of discharge to home, and 30-day hospital readmissions. Secondary outcomes included incidence of postsurgical hypotension and vasopressor use. Subgroup analyses were stratified by surgical procedure (colorectal, abdominal) and approach (endoscopic, open). A generalized linear model adjusted for patient and hospital characteristics was used for all comparisons. A total of 5799 surgical records (LB, n=4820; epidural analgesia, n=979) were included. Compared with cases where LB was administered, cases of epidural analgesia use were associated with a 1.6-day increase in length of stay (adjusted rate ratio [95% confidence interval (CI), 1.2 [1.2-1.3]]; <.0001) and $6304 greater hospital costs (adjusted rate ratio [95% CI], 1.2 [1.2-1.3]]; <.0001). Cost differences were largely driven by room-and-board fees. Epidural analgesia was associated with reduced rates of discharge to home (<.0001) and increased 30-day readmission rates (=.0073) compared with LB. Epidural analgesia was also associated with increased rates of postsurgical hypotension (30% vs 11%; adjusted odds ratio [95% CI], 2.8 [2.3-3.4]; <.0001) and vasopressor use (22% vs 7%; adjusted odds ratio [95% CI], 3.1 [2.5-4.0]; <.0001) compared with LB. Subgroup analyses by surgical procedure and approach were generally consistent with overall comparisons. Our results are consistent with previous studies that demonstrated epidural analgesia can be associated with higher utilization of healthcare resources and complications compared with LB. Compared with epidural analgesia, LB was associated with economic benefits and reduced incidence of postsurgical hypotension and vasopressor use.
硬膜外镇痛尽管在提供阿片类药物节省型疼痛管理方面被广泛使用且具有价值，但可能与高成本和术后风险（如低血压）相关。在这项真实世界研究中，我们检验了脂质体布比卡因（LB）可能是硬膜外镇痛的可靠替代方案这一假设。为比较使用LB和硬膜外镇痛进行腹部手术的经济结果和低血压发生率。这项回顾性分析使用Premier医疗数据库确定了2016年1月至2019年9月期间接受腹部手术并接受LB给药或传统硬膜外镇痛的成年人记录。经济结果包括住院时间、医院成本、回家出院率和30天再入院率。次要结果包括术后低血压发生率和血管升压药使用情况。亚组分析按手术方式（结直肠、腹部）和手术入路（内镜、开放）分层。对患者和医院特征进行调整的广义线性模型用于所有比较。共纳入5799份手术记录（LB组，n = 4820；硬膜外镇痛组，n = 979）。与使用LB的病例相比，使用硬膜外镇痛的病例住院时间延长1.6天（调整率比[95%置信区间（CI），1.2[1.2 - 1.3]]；<.0001），医院成本高出6304美元（调整率比[95%CI]，1.2[1.2 - 1.3]]；<.0001）。成本差异主要由食宿费用驱动。与LB相比，硬膜外镇痛与回家出院率降低（<.0001）和30天再入院率增加（=.0073）相关。与LB相比，硬膜外镇痛还与术后低血压发生率增加（30%对11%；调整优势比[95%CI]，2.8[2.3 - 3.4]；<.0001）和血管升压药使用增加（22%对7%；调整优势比[95%CI]，3.1[2.5 - 4.0]；<.0001）相关。按手术方式和手术入路进行的亚组分析总体上与总体比较一致。我们的结果与先前的研究一致，即与LB相比，硬膜外镇痛可能与更高的医疗资源利用率和并发症相关。与硬膜外镇痛相比，LB具有经济效益，并降低了术后低血压和血管升压药使用的发生率。
