Intravenous Acetaminophen May Be Associated with Reduced Odds of 30-Day Readmission after Total Knee Arthroplasty

Michael A. Mont; Belinda Lovelace; An T. Pham; Ryan N. Hansen; Morad Chughtai; Chukwuweike U. Gwam; Anton Khlopas; John W. Barrington

doi:10.1055/s-0038-1646927

The Journal of Knee Surgery, Table of Contents

J Knee Surg 2019; 32(05): 414-420
DOI: 10.1055/s-0038-1646927

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Intravenous Acetaminophen May Be Associated with Reduced Odds of 30-Day Readmission after Total Knee Arthroplasty

Michael A. Mont

¹Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, New York

,

Belinda Lovelace

²Department of Health Economics and Outcomes Research, Mallinckrodt Pharmaceuticals, Bedminster, New Jersey

,

An T. Pham

³School of Pharmacy, University of California, San Francisco, California

,

Ryan N. Hansen

⁴School of Pharmacy, University of Washington, Seattle, Washington

,

Morad Chughtai

¹Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, New York

,

Chukwuweike U. Gwam

⁵Department of Orthopaedic Surgery, Rubin Institute of Advanced Orthopedics, Baltimore, Maryland

,

Anton Khlopas

¹Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, New York

,

John W. Barrington

⁶Department of Orthopaedic Surgery, Joint Replacement Center of Texas, Plano, Texas

› Author Affiliations

Abstract

The purpose of this study was (1) to evaluate 30-day readmission rates in total knee arthroplasty (TKA) patients who either received intravenous (IV) or oral (PO) acetaminophen (APAP) perioperatively and (2) to extrapolate the potential annual cost savings on the national level. This was a review of 190,691 TKA recipients between the years 2012 and 2015 who received either IV (n = 56,475) or PO APAP (n = 134,216). All-cause readmissions that occurred between patient discharge and 30 days postdischarge were recorded. Continuous and categorical variables were evaluated using t-test and chi-square test, respectively. A logistic regression analysis was conducted to assess the effect of IV APAP on 30-day readmission. We also performed a literature review on 30-day readmission rates and risk prediction tools for TKA and correlated these with our findings. In addition, we extrapolated potential cost savings on the national level. The readmission rate was 0.04% in the IV and 0.14% in the PO APAP cohort (69% decreased risk; odds ratio = 0.31; 95% confidence interval = 0.20–0.47; p < 0.001). The readmission rate in this patient population appears to be markedly lower, when compared with previous reports. This reduction in readmissions may potentially result in $160 million savings per year. The use of IV APAP in TKA patients resulted in lower readmission rates, which may be valuable in clinical decision making by surgeons and health care administrators looking to lower costs of care.

Keywords

intravenous acetaminophen - readmission - total knee arthroplasty - acetaminophen

Full Text

References

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