Data from Pharmawand - Curated by EPG Health - Date added 16 March 2019

Pacira Pharmaceuticals, Inc. announced new data showing that a patient-optimizing, opioid-sparing enhanced recovery after surgery (ERAS) pathway, which includes intraoperative infiltration with Exparel (bupivacaine liposome injectable suspension), results in high rates of early discharge and patient satisfaction among Medicare-insured patients undergoing total knee or hip arthroplasty (TKA or THA).

Findings also demonstrate that the vast majority of patients do not require more than a 7-day opioid prescription following discharge. The research was detailed during a podium presentation at the American Academy of Orthopaedic Surgeons (AAOS) 2019 Annual Meeting in Las Vegas. Retrospective chart review data were captured for 645 consecutive Medicare patients who underwent primary inpatient TKA (337 patients) or THA (308 patients) between June 1, 2015, and November 16, 2017. All patients followed a procedure-specific ERAS protocol; key findings included:• 84% of patients were same-day discharged to home, without home services, following their joint replacement.• 84.2% did not require any additional opioid prescriptions beyond the initial 7-day prescription provided at discharge. Nationally, 38% of knee replacement patients are still taking opioids 2 months after surgery. • Patients reported high satisfaction with their perioperative experience. 98.9% of patients reported they would recommend the surgical facility “very much” or “a good amount”. 98.3% were “very much” or “a good amount” satisfied with their pain management. 97% were “very much” or “a good amount” satisfied with the education and communication they received. Comparable or lower complication rates to nationally reported rates: “Our findings suggest that potential exists for Medicare-insured patients to undergo safe and successful TKA or THA procedures as outpatient surgery with same-day discharge to home. Since the completion of our study, more than ninety percent of patients safely and comfortably go home the day of surgery,” said Orthopedic Surgeon James Van Horne, of Paragon Orthopedic Center in Grants Pass, OR, who performed all 645 surgeries and authored this analysis.

“This ERAS protocol, which was developed over the last ten years to maximize the number of Medicare patients who could safely and reproducibly undergo outpatient joint replacement, suggests an important advance in our ability to offer these patients quality care that meets the ‘Triple Aim’ of healthcare by improving the patient experience and population health while reducing healthcare costs.”

All patients received a procedure-specific ERAS protocol that included: • Presurgical physical, medical, and social optimization: including assistance with stabilization of medical issues/modifiable risk factors; postsurgical rehabilitation training; and development of a social support network. • Individualized multimodal pain management: including a non-opioid pain management regimen started one week preoperatively; spinal anesthesia, awake sedation and local infiltration with EXPAREL and bupivacaine HCl intraoperatively; and a non-opioid pain management regimen alongside a 7-day supply of opioids as needed postoperatively.• Patient and caregiver education before and after surgery: including setting realistic expectations for pain; opioid risks and tapering instructions; and wound care information.

Dr. Van Horne’s podium presentation, entitled Enhanced Recovery After Surgery Pathway for Total Knee and Hip Arthroplasty in a Medicare Population: Implications for a Transition to Ambulatory Surgery Centers, was Paper 151 at AAOS. It was presented from the podium on Tuesday, March 12 at 1:30 pm PT.


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