IV Acetaminophen Results in Lower Hospital Costs and Emergency Room Visits Following Bariatric Surgery: a Double-Blind, Prospective, Randomized Trial in a Single Accredited Bariatric Center

• Published in: Journal of gastrointestinal surgery 2016-04, Vol.20 (4), p.715-724
• Main Authors: El Chaar, Maher, Stoltzfus, Jill, Claros, Leonardo, Wasylik, Tara
• Format: Article
• Language: English
• Subjects: Accreditation; Acetaminophen - administration & dosage; Acetaminophen - economics; Administration, Intravenous; Adult; Analgesics; Analgesics, Non-Narcotic - administration & dosage; Analgesics, Non-Narcotic - economics; Body mass index; Clinical trials; Comorbidity; Cost control; Double-Blind Method; Economic impact; Emergency medical care; Emergency Service, Hospital - economics; Emergency Service, Hospital - statistics & numerical data; Female; Gastrectomy - adverse effects; Gastrectomy - economics; Gastrectomy - methods; Gastric Bypass - adverse effects; Gastric Bypass - economics; Gastric Bypass - methods; Gastroenterology; Gastrointestinal surgery; Health care networks; Hospital costs; Hospital Costs - statistics & numerical data; Humans; Laparoscopy; Laparoscopy - adverse effects; Length of stay; Length of Stay - economics; Male; Medicine; Medicine & Public Health; Middle Aged; Narcotics; Obesity, Morbid - surgery; Original Article; Pain; Pain, Postoperative - drug therapy; Patient Satisfaction; Prospective Studies; Sleep apnea; Surgery
• ISSN: 1091-255X; 1873-4626
• DOI: 10.1007/s11605-016-3088-0

Background Postoperative pain control in bariatric surgery is challenging, despite use of intravenous (IV) narcotics. IV acetaminophen is one pain control alternative. Objective The aim of this study was to investigate the economic impact of IV acetaminophen in bariatric surgery and its effect on patients’ pain, satisfaction, and hospital length of stay. Methods In a randomized controlled trial, Group 1 (treatment) received IV acetaminophen plus IV narcotics 30 min before surgery, then medication plus IV narcotics/PO narcotics for the remaining 18 h. Group 2 (control) received IV normal saline plus IV/PO narcotics. Patients underwent laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (SG). Primary outcomes included direct hospital costs, length of stay, postoperative pain, and patient satisfaction. Secondary outcomes included indirect costs, rescue narcotics dosage, and 30-day outcomes. Results Mean direct hospital cost in the treatment group ( n  = 50) was $3089.18 versus $2991.62 for the control group ( n  = 50) ( p  > 0.05). Pain scores did not differ significantly ( p  = 0.61). After adjusting for surgery type, there was no significant difference in length of stay ( p  = 0.95). Significantly more control group patients incurred surgery-related indirect costs (10 versus 2 %, p