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Intravenous Acetaminophen Reduces Length of Stay Via Mediation of Postoperative Opioid Consumption After Posterior Spinal Fusion in a Pediatric Cohort

Olbrecht, Vanessa A. MD, MBA*,†; Ding, Lili PhD†,‡; Spruance, Kristie BS*; Hossain, Monir PhD§; Sadhasivam, Senthilkumar MD, MPH*,†,‖; Chidambaran, Vidya MD*,†

The Clinical Journal of Pain: July 2018 - Volume 34 - Issue 7 - p 593–599
doi: 10.1097/AJP.0000000000000576
Original Articles

Objectives: Since approval of intravenous acetaminophen (IV APAP), its use has become quite common without strong positive evidence. Our goal was to determine the effect of IV APAP on length of hospital stay (LOS) via mediation of opioid-related side effects in pediatric patients.

Materials and Methods: After Institutional Review Board approval, 114 adolescents undergoing posterior spinal fusion were prospectively recruited and managed postoperatively with patient-controlled analgesia and adjuvant therapy. Patients were divided into 2 groups based on the use of IV APAP: control (n=70) and treatment (n=44). Association of IV APAP use with opioid outcomes was analyzed using inverse probability of treatment weighting (IPTW)-adjusted propensity scores to balance the 2 groups for all significant covariates except postoperative opioid consumption. Mediation analysis was carried out for LOS with IV APAP as the independent variable and morphine consumption as the mediator.

Results: Oral intake was delayed by ∼1 day (P<0.001) and LOS was 0.6 days longer in the control group (P=0.044). After IPTW, time to oral intake remained significantly longer in the control group (P=0.014). The mediation model with IPTW revealed a significant negative association between IV APAP and morphine consumption (P<0.001), which significantly increased LOS (P<0.003). IV APAP had a significant opioid-sparing effect associated with shorter LOS.

Discussion: IV APAP hastens oral intake and is associated with decreased LOS in an adolescent surgery population likely through decreased opioid consumption. Through addition of IV APAP in this population, LOS may be decreased, an important implication in the setting of escalating health care costs.

Departments of *Anesthesia


Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center

§Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital, Cincinnati, OH

Riley Children’s Hospital, Indianapolis, Indiana

The work was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, MD (5K23HD082782) to (V.C.). The authors declare no conflict of interest.

Reprints: Vanessa A. Olbrecht, MD, MBA, Departments of Anesthesia and Pediatrics, 3333 Burnet Ave., MLC 2001, Cincinnati Children’s Hospital, Cincinnati, OH 45242 (e-mail:

Received May 26, 2017

Received in revised form November 16, 2017

Accepted November 13, 2017

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