IMPROVED POSTOPERATIVE CLINICAL AND DISCHARGE OUTCOMES FOR LIPOSOMAL BUPIVACAINE COMPARED TO BUPIVACAINE

OBJECTIVES: While more than 300,000 total hip arthroplasties (THA) are performed annually in the United States, there is no gold standard for an effective postoperative THA pain strategy. The objective of this retrospective cohort study was to compare clinical, and discharge outcomes for patients utilizing an extended-release liposomal bupivacaine (LB) to a control cohort utilizing bupivacaine. METHODS: The LB cohort included 64 consecutive THA patients from one surgeon at a single institution between August 2013 and July 2015 and 66 consecutive THA procedures performed by the same surgeon between June 2011 and July 2013 were selected as the control cohort. Clinical (pain [VAS], distance walked, opioid use, falls) and discharge (discharge destination, length of stay[LOS], readmission rates) outcomes were compared on post-operation day (POD) 0, 1 and 2 using univariate and multivariate analyses. RESULTS: The LB cohort showed significantly lower AUC VAS pain scores on POD 0, 1 and 2. Significantly fewer LB patients used rescue opioids on POD1 and POD2. LOS decreased significantly from 2.7 to 2.0 days and 30% more LB patients were discharged at POD1. After adjusting for covariates, LB patients were more likely to walk farther than controls after surgery. LB cohort had significantly fewer 30-day readmissions than the control cohort. For patients with available financial data, adjusted mean hospital charge costs were lower in the LB patients. Categorically, the LB cohort had lower costs than the control cohort for room, medical and surgical supplies, diagnostic test (including labs and operation), and physical therapy. There were no differences in falls or discharge location. CONCLUSIONS: This retrospective cohort study comparing LB to bupivacaine demonstrated improved perioperative pain management, less opioid use, decreased length of stay, lower costs, earlier discharge and increased physical function.