PSU5 Liposomal Bupivacaine and Inpatient Hospital Costs after Colorectal Surgery

Abstract

To compare total costs of care between patients who received liposomal bupivacaine (LB) versus those who did not (control) from a health institution perspective. This economic evaluation was conducted among adults undergoing open or minimally invasive colorectal resection at an academic medical center from May 2016 to February 2018. Patients with surgery after hospital day 2 or ostomy were excluded. The primary analysis used public charges. A sensitivity analysis used hospital-specific costs. Healthcare resource utilization was derived from the electronic health record. Total costs of care (in 2018 USD) were analyzed using a generalized linear model adjusted for American Society of Anesthesiologists score, enhanced recovery after surgery management, open surgery, opioid use before surgery, height, cancer, and age. Of 486 included patients, 286 (59%) received LB. Total costs of care using public charges included perioperative local anesthetic use (mean ± SD; $392 ± 74 LB vs. $8 ± 13 control), analgesia 48-hour after surgery ($132 ± 99 LB vs. $117 ± 127 control), postoperative ileus management ($5 ± 51 LB vs. $65 ± 284 control), and hospital length of stay ($4,459 ± 3,576 LB vs. $7,769 ± 7,082 control). After adjusting for covariates, LB was associated with an average reduction in total costs of care of $1,435 (95%CI [470 to 2,401]; p=0.004) using public charges and $1,345 (95%CI [476 to 2,215]; p=0.002) using hospital-specific costs. In a sensitivity analysis where administration of LB was assumed to increase operating room time by 5 minutes, LB was associated with a significant reduction in total costs of care as long as cost per minute of operating room time was ≤$80. Following colorectal surgery, LB was associated with a significant reduction in total costs of care that were predominately driven by reduced costs for hospital stay and postoperative ileus management despite higher medication costs.