Defining the Value of Analgesia for Total Knee Arthroplasty Using Time-Driven Activity-Based Costing: A Novel Approach to Clinical Practice Transformation
| Autor: | Kathryn W. Zavaleta, Matthew P. Abdel, Hugh M. Smith, Adam K. Jacob, Ram Jagannathan, Adam W. Amundson, Alvin M. Tsang, Eugene C. Dankbar |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
CACB
continuous adductor canal block Medicine (General) Adductor canal business.industry Analgesic Total knee arthroplasty ACB adductor canal block TDABC time-driven activity-based costing POD postoperative day Blockade SACB single-injection adductor canal block Clinical Practice medicine.anatomical_structure R5-920 Hospital outcomes ABC activity-based costing Anesthesia medicine In patient Original Article PAI periarticular infiltration Opiate business LOS length of stay |
| Zdroj: | Mayo Clinic Proceedings: Innovations, Quality & Outcomes, Vol 5, Iss 6, Pp 1042-1049 (2021) Mayo Clinic Proceedings: Innovations, Quality & Outcomes |
| ISSN: | 2542-4548 |
| Popis: | Objective To compare the relative value of 3 analgesic pathways for total knee arthroplasty (TKA). Patients and Methods Time-driven activity-based costing analyses were performed on 3 common analgesic pathways for patients undergoing TKA: periarticular infiltration (PAI) only, PAI and single-injection adductor canal blockade (SACB), and PAI and continuous adductor canal blockade (CACB). Additionally, adult patients who underwent elective primary TKA from November 1, 2017, to May 1, 2018, were retrospectively identified to analyze analgesic (pain score, opiate use) and hospital outcomes (distance walked, length of stay) after TKA based on analgesic pathway. Results There was no difference in patient demographic characteristics, specifically complexity (American Society of Anesthesiologists score) or preoperative opiate use, between groups. Compared with PAI, total cost (labor and material) was 1.4-times greater for PAI plus SACB and 2.3-times greater for PAI plus CACB. The addition of SACB to PAI resulted in lower average and maximum pain scores and opiate use on the day of operation compared with PAI alone. Average and maximum pain scores and opiate use between SACB and CACB were not significantly different. Walking distance and hospital length of stay were not significantly different between groups. Conclusion Perioperative care teams should consider the cost and relative value of pain management when selecting the optimal analgesic strategy for TKA. Despite slightly higher relative cost, the combination of SACB with PAI may offer short-term analgesic benefit compared with PAI alone, which could enhance its relative value in TKA. |
| Databáze: | OpenAIRE |
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