RETROSPECTIVE DATABASE ANALYSIS OF HOSPITAL LENGTH OF STAY, DISCHARGE LOCATION, AND READMISSIONS AMONG PATIENTS UNDERGOING TOTAL KNEE ARTHROPLASTY (TKA) IN THE UNITED STATES
Author(s)
Kang A1, Dagenais S1, Corman SL2
1Pacira Pharmaceuticals, Inc., Parsippany, NJ, USA, 2Pharmerit International, Bethesda, MD, USA
Presentation Documents
OBJECTIVES: To compare hospital length of stay, discharge disposition, and readmission rates among patients undergoing TKA receiving different interventions for postsurgical analgesia. METHODS: The Premier Perspectives® Database was searched to identify patients undergoing ICD-9 procedure code 81.54 from January 1, 2011, to September 30, 2015. Postsurgical analgesic interventions, including single-injection peripheral nerve block (sPNB), continuous peripheral nerve block (cPNB), continuous epidural analgesia (CEA), continuous wound infiltration (CWI), intravenous patient-controlled analgesia (IVPCA), and bupivacaine liposome injectable suspension (BLIS), were identified using Current Procedural Technology (CPT) codes and standard charge codes. Outcomes included LOS, discharge to home or home health, and 90-day all-cause readmissions. Generalized linear mixed models (GLMMs) with log transformation were applied to LOS with gamma distribution, while GLMMs with logit link and binary distribution were used for discharge disposition and readmission. RESULTS: A total of 125,926 patients met inclusion criteria. Mean hospital LOS was significantly shorter in patients receiving BLIS (2.6 days; N=46,590) than those receiving IVPCA (3.3 days; N=36,963), sPNB (3.1 days; N=11,351), CWI (3.0 days; N=24,094), cPNB (3.0 days; N=6229), and CEA (2.7 days; N=685) (p<0.05 for BLIS vs. all other groups). The percentage of patients discharged home was highest in the CEA group (81.0%), followed by cPNB (74.6%), BLIS (74.5%), sPNB (73.6%), CWI (66.4%), and IVPCA (64.0%) (p<0.05 for BLIS vs. CEA, CWI, and IVPCA). Ninety-day readmission rate was significantly lower in patients receiving BLIS (4.2%) compared to CEA (8.5%) and cPNB (4.8%), but was similar to the IVPCA (4.4%), sPNB, and CWI (4.0% each) groups (p<0.05 for BLIS vs. cPNB and CEA). CONCLUSIONS: TKA patients receiving BLIS for postsurgical analgesic had a shorter hospital LOS than those receiving other interventions. Patients receiving CEA were most likely to be discharged home, but had the highest 90-day readmission rate.
Conference/Value in Health Info
2016-10, ISPOR Europe 2016, Vienna, Austria
Value in Health, Vol. 19, No. 7 (November 2016)
Code
PSY95
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
Musculoskeletal Disorders, Systemic Disorders/Conditions
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