PubTransformer

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PMID- 29292341
OWN - NLM
STAT- MEDLINE
DCOM- 20180104
LR  - 20180104
IS  - 2049-4408 (Electronic)
IS  - 2049-4394 (Linking)
VI  - 100-B
IP  - 1 Supple A
DP  - 2018 Jan
TI  - Cost-effective peri-operative pain management: assuring a happy patient after
      total knee arthroplasty.
PG  - 55-61
LID - 10.1302/0301-620X.100B1.BJJ-2017-0549.R1 [doi]
AB  - AIMS: The aim of this study was to determine the optimal regimen for the
      management of pain following total knee arthroplasty (TKA) by comparing the
      outcomes and cost-effectiveness of different protocols implemented at a large,
      urban, academic medical centre. PATIENTS AND METHODS: Between September 2013 and 
      September 2015, we used a series of modifications to our standard regimen for the
      management of pain after TKA. In May 2014, there was a department-wide transition
      from protocols focused on femoral nerve blocks (FNB) to periarticular injections 
      of liposomal bupivacaine. In February 2015, patient-controlled analgesia (PCA)
      was removed from the protocol while continuing liposomal bupivacaine injections. 
      Quality measures and hospital costs were compared between the three protocols.
      RESULTS: The cohort being treated with PCA-less liposomal bupivacaine injections 
      had a significantly higher percentage of patients who were discharged to their
      home (p = 0.010) and a significantly shorter length of stay (p < 0.001).
      Patient-reported Hospital Consumer Assessment of Healthcare Providers and Systems
      (HCAHPS) scores relating to pain being "well-controlled" and "overall pain
      management" also favoured this cohort (p = 0.214 and p = 0.463, respectively), in
      which cost was significantly lower compared with the other two cohorts (p =
      0.005). CONCLUSION: The replacement of FNBs injections and the removal of PCAs,
      both of which are known to be associated with high rates of adverse outcomes, and
      the addition of liposomal bupivacaine periarticular injections to a multimodal
      pain regimen, led to improvements in many quality measures, HCAHPS pain scores,
      and cost-effectiveness. Cite this article: Bone Joint J 2018;100-B(1 Supple
      A):55-61.
CI  - (c)2018 The British Editorial Society of Bone & Joint Surgery.
FAU - Kim, K
AU  - Kim K
AD  - NYU Langone Medical Centre, Hospital for Joint Diseases, 301 E 17th Street, New
      York, NY 10003, USA.
FAU - Elbuluk, A
AU  - Elbuluk A
AD  - NYU Langone Medical Centre, Hospital for Joint Diseases, 301 E 17th Street, New
      York, NY 10003, USA.
FAU - Yu, S
AU  - Yu S
AD  - NYU Langone Medical Centre, Hospital for Joint Diseases, 301 E 17th Street, New
      York, NY 10003, USA.
FAU - Iorio, R
AU  - Iorio R
AD  - NYU Langone Medical Centre, Hospital for Joint Diseases, 301 E 17th Street, New
      York, NY 10003, USA.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - England
TA  - Bone Joint J
JT  - The bone & joint journal
JID - 101599229
SB  - AIM
SB  - IM
MH  - Academic Medical Centers/economics/standards
MH  - Aged
MH  - *Arthroplasty, Replacement, Knee
MH  - Clinical Protocols
MH  - *Cost-Benefit Analysis
MH  - Female
MH  - Hospital Costs/*statistics & numerical data
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - New York City
MH  - Pain Management/adverse effects/economics/*methods
MH  - Pain Measurement
MH  - Pain, Postoperative/diagnosis/economics/*therapy
MH  - Patient Satisfaction/economics/statistics & numerical data
MH  - Quality Improvement/economics/statistics & numerical data
MH  - Quality Indicators, Health Care/economics/statistics & numerical data
MH  - Retrospective Studies
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Liposomal bupivacaine
OT  - Pain management
OT  - Total knee arthroplasty
OT  - Value-based care
EDAT- 2018/01/03 06:00
MHDA- 2018/01/05 06:00
CRDT- 2018/01/03 06:00
PHST- 2017/05/05 00:00 [received]
PHST- 2017/06/21 00:00 [accepted]
PHST- 2018/01/03 06:00 [entrez]
PHST- 2018/01/03 06:00 [pubmed]
PHST- 2018/01/05 06:00 [medline]
AID - 100-B/1_Supple_A/55 [pii]
AID - 10.1302/0301-620X.100B1.BJJ-2017-0549.R1 [doi]
PST - ppublish
SO  - Bone Joint J. 2018 Jan;100-B(1 Supple A):55-61. doi:
      10.1302/0301-620X.100B1.BJJ-2017-0549.R1.