title: 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.
abstract: 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 < 0.05), with greater presentation to the emergency department (ED) for abdominal pain (5/50 versus 1/50), yielding higher total indirect costs ($39,293 versus $13,185).
  
  
  CONCLUSIONS
  Using IV acetaminophen for postoperative pain management produced notable indirect cost savings and reduced ED visits in the first 30 days postoperatively, with good safety and tolerance. Decreased statistical power may have accounted for certain non-significant findings.
authors: Medical School of Temple University/St. Luke's University Health Network, 240 Cetronia Road, Suite 205, North Allentown, PA, 18104, USA. Maher.Elchaar@sluhn.org.
authors: Maher
authors: M
authors: El Chaar
authors: Medical School of Temple University/St. Luke's University Health Network, 240 Cetronia Road, Suite 205, North Allentown, PA, 18104, USA.
authors: Jill
authors: J
authors: Stoltzfus
authors: Medical School of Temple University/St. Luke's University Health Network, 240 Cetronia Road, Suite 205, North Allentown, PA, 18104, USA.
authors: Leonardo
authors: L
authors: Claros
authors: Medical School of Temple University/St. Luke's University Health Network, 240 Cetronia Road, Suite 205, North Allentown, PA, 18104, USA.
authors: Tara
authors: T
authors: Wasylik
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage* / Q000191:economics; D061605:Administration, Intravenous; D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage* / Q000191:economics; D004311:Double-Blind Method; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000191:economics* / Q000379:methods; D015390:Gastric Bypass / Q000009:adverse effects / Q000191:economics* / Q000379:methods; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery; D010149:Postoperative Pain / Q000188:drug therapy*; D017060:Patient Satisfaction; D011446:Prospective Studies
chemical_list: D018712:Analgesics, Non-Narcotic; D000082:Acetaminophen
keywords: Bariatric surgery; Direct costs; Hospital length of stay; Indirect costs; Intravenous acetaminophen; Patient satisfaction; Postoperative pain control