Estimating the Effect of Intravenous Acetaminophen for Postoperative Pain Management on Length of Stay and Inpatient Hospital Costs.

INTRODUCTION: The provision of safe, effective, cost-efficient perioperative inpatient acute pain management is an important concern among clinicians and administrators within healthcare institutions. Overreliance on opioid monotherapy in this setting continues to present health risks for patients and increase healthcare costs resulting from preventable adverse events. The goal of this study was to model length of stay (LOS), potential opioid-related complications, and costs for patients reducing opioid use and adding intravenous acetaminophen (IV APAP) for management of postoperative pain. METHODS: Data for this study were de-identified inpatient encounters from The Advisory Board Company across 297 hospitals from 2012-2014, containing 2,238,433 encounters (IV APAP used in 12.1%). Encounters for adults ≥18 years of age admitted for cardiovascular, colorectal, general, obstetrics and gynecology, orthopedics, or spine surgery were included. The effects of reducing opioids and adding IV APAP were estimated using hierarchical statistical models. Costs were estimated by multiplying modeled reductions in LOS or complication rates by observed average volumes for medium-sized facilities, and by average cost per day or per complication (LOS: US$2383/day; complications: derived from observed charges). RESULTS: Across all surgery types, LOS showed an average reduction of 18.5% (10.7-32.0%) for the modeled scenario of reducing opioids by one level (high to medium, medium to low, or low to none) and adding IV APAP, with an associated total LOS-related cost savings of $4.5 M. Modeled opioid-related complication rates showed similar improvements, averaging a reduction of 28.7% (5.4-44.0%) with associated cost savings of $0.2 M. In aggregate, costs decreased by an estimated $4.7 M for a medium-sized hospital. The study design demonstrates associations only and cannot establish causal relationships. The cost impact of LOS is modeled based on observed data. CONCLUSIONS: This investigation indicates that reducing opioid use and including IV APAP for postoperative pain management has the potential to decrease LOS, opioid-related complication rates, and costs from a hospital perspective. FUNDING: Mallinckrodt Pharmaceuticals.

Use of 2001-2002 Behavioral Risk Factor Surveillance System data to characterize cancer survivors in North Carolina.

OBJECTIVE: We used Behavioral Risk Factor Surveillance System (BRFSS) data to examine demographic characteristics, health status, quality of life, and preventive health behaviors among adult cancer survivors in North Carolina. METHODS: We analyzed responses to state-added questions on cancer survivorship and to standard BRFSS questions concerning health status, quality of life, and health behaviors, including access of preventive services associated with cancer prevention and early detection, from the 2001 and 2002 North Carolina BRFSS. RESULTS: Cancer survivors were more likely than individuals with no self-reported history of cancer to be women (62.7% vs 51.3%), white (80.8% vs 70.3%), aged 65 years or older (48.7% vs 13.8%), and up to date with colorectal cancer screening (66.4% vs 52.4%); as likely to be current smokers (28.0% vs 26.2%); and more likely to report poor or fair health status (28.2% vs 17.2%). Cancer survivors reported lower quality of life, measured as the number of physically and mentally unhealthy days in the previous 30 days. LIMITATIONS: This was a cross-sectional survey that relied on self-reported history of cancer, healthy behaviors, and use of preventive services. CONCLUSIONS: Data from a statewide, population-based survey can be used to assess unmet needs of cancer survivors. Comprehensive cancer-control programs should be able to design interventions and monitor progress of state cancer-survivorship goals.

Attitudes about tobacco policies among North Carolina parents.

BACKGROUND: While tobacco use reduction remains a major public health goal, little evidence exists on how citizens in North Carolina view policy issues related to tobacco control. This research examines attitudes toward tobacco policies among North Carolina parents. METHODS: Randomly selected North Carolina adults with a child living in his or her household were invited to participate in the Child Health Assessment and Monitoring Program (CHAMP) telephone survey. A sample of 3,973 parents or guardians was interviewed in 2005. Support for tobacco prevention and policies was analyzed by demographic characteristics. RESULTS: Of the 86% of initial respondents who were eligible to participate, 83% completed the 2005 CHAMP survey. Most parents in North Carolina (90.1%) support stronger policies for tobacco prevention. Parents also strongly support restrictions on tobacco in schools (85.6%) and recreational areas and fast food restaurants (83.9%). While many parents report being well prepared to talk to their children about smoking (97.6%) and report talking about the dangers of smoking monthly (84.7%), few report that their child currently smokes (3.9% of high school students and 0.6% of middle school students). LIMITATIONS: Because the CHAMP survey is telephone-based the results are limited to North Carolina parents who have a land-line telephone. CONCLUSIONS: Despite the states historical ties to tobacco, the overwhelming majority of North Carolina parents are in favor of stronger efforts at tobacco use prevention, including increased policy measures. These results suggest that prevention efforts should be expanded and that policy makers who take a stronger stance against tobacco will most likely receive broad support by North Carolina parents.