Abstract
Background: An Acute Pain Service (APS) has been shown to improve patient outcomes and decrease complications by achieving adequate pain control and decreasing opioid use. However, it is less obvious if having a dedicated APS postoperatively directly translates to patient-centered or hospital cost benefits. This study aimed to determine if there was a cost benefit between a matched cohort of patients with and without a dedicated APS after a planned ventral wall hernia repair. Methods: A historical cohort study was conducted. After 1:1 matching, 40 patients were included for analysis. The non-APS group received a thoracic epidural postoperatively managed by the anesthesiology department. The APS group received various continuous peripheral nerve blocks and analgesia exclusively managed by a dedicated APS. Data was recorded for each group regarding surgical techniques, postoperative complications, opioid use and induced side effects, hospital length of stay, and resource utilization for both groups. Results: Compared to the non-APS group, adjusted opioid consumption per day was almost half in the APS group (P= 0.0067). The average hospital length of stay was 3.4 days less (P= 0.0401) , and there was a statistically significant reduction in several recovery milestones that likely contributed to a timely discharge in the APS group. After factoring costs of APS utilization, the APS was shown to save an average of $5,440.59 of total cost per patient. Discussion: The addition of a dedicated postoperative APS significantly reduced opioid consumption and improved outcomes of patients and resulted in reduced healthcare costs.
Highlights
The Acute Pain Service (APS) was developed in the late 1980’s to provide an increased level of vigilance for advanced pain management
The average hospital length of stay was 3.4 days less (P= 0.0401), and there was a statistically significant reduction in several recovery milestones that likely contributed to a timely discharge in the APS group
This study sought to discover whether, in addition to a continuous regional analgesia technique, the active management of a dedicated APS translated into cost savings for patients undergoing planned ventral hernia repair
Summary
The Acute Pain Service (APS) was developed in the late 1980’s to provide an increased level of vigilance for advanced pain management. APS intervention utilized Intravenous Patient-Controlled Analgesia (IV PCA); the side effects were significant and treatment has evolved to utilize continuous epidurals and ultrasound-guided Continuous Peripheral Nerve Block (CPNB) infusions [1]. These modalities are often further combined with Multimodal Analgesia (MMA) and actively managed by the APS [2]. An Acute Pain Service (APS) has been shown to improve patient outcomes and decrease complications by achieving adequate pain control and decreasing opioid use It is less obvious if having a dedicated APS postoperatively directly translates to patient-centered or hospital cost benefits. This study aimed to determine if there was a cost benefit between a matched cohort of patients with and without a dedicated APS after a planned ventral wall hernia repair
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