title: The value of continuous wound infusion systems for postoperative pain control following laparoscopic Roux-en-Y gastric bypass: an analysis of outcomes and cost.
abstract: BACKGROUND
  Current health-care reform is focusing on improving patient outcomes while cutting health-care costs, and as such, surgeons should consider that postoperative pain management techniques can contribute to the overall value of care delivered to patients. The current study aims to evaluate the value of continuous wound infusion systems (CWIS) in patients following laparoscopic Roux-en-Y gastric bypass (LRYGB).
  
  
  METHODS
  Records of all consecutive patients who underwent elective LRYGB by a single surgeon from January 2008 until June 2010 were reviewed. The presence of CWIS, patient pain scores, postanesthesia care unit (PACU) times, postoperative narcotic and antiemetic requirements, postoperative complications, and hospital length of stay (LOS) were recorded. Clinical data were subsequently linked and correlated with hospital financial data to determine overall hospital costs.
  
  
  RESULTS
  Forty-four LRYGB patients were reviewed; 24 (54.5 %) received CWIS for postoperative pain control. There was no significant difference in PACU times, postoperative LOS, or postoperative complications. Patients with CWIS required significantly less narcotics (36.7 vs. 55.5 mg IV morphine equivalents for total LOS; p = 0.03) and antiemetics (5.0 vs. 12.4 mg ondansetron for total LOS; p = 0.02); however, patients with CWIS did not report better pain control and had slightly higher hospital costs ($13,627.00 vs. $13,395.05, p = 0.68).
  
  
  CONCLUSIONS
  Data from the current study suggest that the value of CWIS for postoperative pain control following LRYGB is limited. As the environment for hospital reimbursement is changing to be one which is value driven, surgeons should consider analyses such as this when making decisions on which treatments to offer their patients.
authors.affiliation: Division of General and Gastrointestinal Surgery, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: Rachel L
authors.initials: RL
authors.lastname: Medbery
authors.forename: Amareshwar
authors.initials: A
authors.lastname: Chiruvella
authors.forename: Jahnavi
authors.initials: J
authors.lastname: Srinivasan
authors.forename: John F
authors.initials: JF
authors.lastname: Sweeney
authors.forename: Edward
authors.initials: E
authors.lastname: Lin
authors.forename: S Scott
authors.initials: SS
authors.lastname: Davis
mesh_terms: D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage*; D005260:Female; D015390:Gastric Bypass; D017721:Hospital Costs; D006801:Humans; D007260:Infusion Pumps; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery; D010149:Postoperative Pain / Q000517:prevention & control*; D011183:Postoperative Complications / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local; D002045:Bupivacaine