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Intravenous Acetaminophen Does Not Reduce Inpatient Opioid Prescription or Opioid-Related Adverse Events Among Patients Undergoing Spine Surgery

Mörwald, Eva E. MD*,†; Poeran, Jashvant MD, PhD‡,§,¶; Zubizarreta, Nicole MPH; Cozowicz, Crispiana MD*,†; Mazumdar, Madhu PhD; Memtsoudis, Stavros G. MD, PhD, FCCP*,†

doi: 10.1213/ANE.0000000000003344
Chronic Pain Medicine: Original Clinical Research Report
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BACKGROUND: Having entered the US market relatively recently, the perioperative role of intravenous acetaminophen (ivAPAP) remains to be established for several surgeries. Using national data, we therefore assessed current utilization and whether it reduces inpatient opioid prescription and opioid-related side effects in a procedure with relatively high opioid utilization.

METHODS: Patients undergoing a lumbar/lumbosacral spinal fusion (n = 117,269; 2011–2014) were retrospectively identified in a nationwide database and categorized by the amount and timing of ivAPAP administration (1 or >1 dose on postoperative day [POD] 0, 1, or 1+). Multivariable models measured associations between ivAPAP utilization categories and opioid prescription and perioperative complications; odds ratios (or % change) and 95% confidence intervals are reported.

RESULTS: Overall, ivAPAP was used in 18.9% (n = 22,208) of cases of which 1 dose on POD 0 was the most common (73.6%; n = 16,335). After covariate adjustment, use of ivAPAP on POD 0 and 1 was associated with minimal changes in opioid prescription, length and cost of hospitalization particularly favoring >1 ivAPAP dose with a modestly (−5.2%, confidence interval, −7.2% to −3.1%; P < .0001) decreased length of stay. Use of ivAPAP did not coincide with a consistent pattern of significantly reduced odds for complications. In comparison, the most commonly used nonopioid analgesic, pregabalin/gabapentin, did demonstrate reduced opioid prescription combined with lower complication risk.

CONCLUSIONS: We could not show that perioperative ivAPAP reduces inpatient opioid prescription with subsequent reduced odds for adverse outcomes. It remains to be determined if and under what circumstances ivAPAP has a meaningful clinical role in everyday practice.

From the *Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York

Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria

Institute for Healthcare Delivery Science, Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, New York

§Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York

Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.

Published ahead of print March 27, 2018.

Accepted for publication February 2, 2018.

Funding: S.G.M. is funded by the Anna Maria and Stephen Kellen Career Development Award, New York.

The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website.

Reprints will not be available from the authors.

Address correspondence to Stavros G. Memtsoudis, MD, PhD, FCCP, Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, Weill Cornell Medical College, 535 E 70th St, New York, NY 10021. Address e-mail to memtsoudiss@hss.edu.

Copyright © 2018 International Anesthesia Research Society
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