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Defining the Value of Analgesia for Total Knee Arthroplasty Using Time-Driven Activity-Based Costing: A Novel Approach to Clinical Practice Transformation

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-injec...

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Autores principales: Tsang, Alvin M., Jagannathan, Ram, Amundson, Adam W., Smith, Hugh M., Dankbar, Eugene C., Zavaleta, Kathryn W., Abdel, Matthew P., Jacob, Adam K.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8572874/
https://www.ncbi.nlm.nih.gov/pubmed/34765887
http://dx.doi.org/10.1016/j.mayocpiqo.2021.09.005
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author Tsang, Alvin M.
Jagannathan, Ram
Amundson, Adam W.
Smith, Hugh M.
Dankbar, Eugene C.
Zavaleta, Kathryn W.
Abdel, Matthew P.
Jacob, Adam K.
author_facet Tsang, Alvin M.
Jagannathan, Ram
Amundson, Adam W.
Smith, Hugh M.
Dankbar, Eugene C.
Zavaleta, Kathryn W.
Abdel, Matthew P.
Jacob, Adam K.
author_sort Tsang, Alvin M.
collection PubMed
description 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.
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spelling pubmed-85728742021-11-10 Defining the Value of Analgesia for Total Knee Arthroplasty Using Time-Driven Activity-Based Costing: A Novel Approach to Clinical Practice Transformation Tsang, Alvin M. Jagannathan, Ram Amundson, Adam W. Smith, Hugh M. Dankbar, Eugene C. Zavaleta, Kathryn W. Abdel, Matthew P. Jacob, Adam K. Mayo Clin Proc Innov Qual Outcomes Original Article 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. Elsevier 2021-10-30 /pmc/articles/PMC8572874/ /pubmed/34765887 http://dx.doi.org/10.1016/j.mayocpiqo.2021.09.005 Text en © 2021 THE AUTHORS https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Original Article
Tsang, Alvin M.
Jagannathan, Ram
Amundson, Adam W.
Smith, Hugh M.
Dankbar, Eugene C.
Zavaleta, Kathryn W.
Abdel, Matthew P.
Jacob, Adam K.
Defining the Value of Analgesia for Total Knee Arthroplasty Using Time-Driven Activity-Based Costing: A Novel Approach to Clinical Practice Transformation
title Defining the Value of Analgesia for Total Knee Arthroplasty Using Time-Driven Activity-Based Costing: A Novel Approach to Clinical Practice Transformation
title_full Defining the Value of Analgesia for Total Knee Arthroplasty Using Time-Driven Activity-Based Costing: A Novel Approach to Clinical Practice Transformation
title_fullStr Defining the Value of Analgesia for Total Knee Arthroplasty Using Time-Driven Activity-Based Costing: A Novel Approach to Clinical Practice Transformation
title_full_unstemmed Defining the Value of Analgesia for Total Knee Arthroplasty Using Time-Driven Activity-Based Costing: A Novel Approach to Clinical Practice Transformation
title_short Defining the Value of Analgesia for Total Knee Arthroplasty Using Time-Driven Activity-Based Costing: A Novel Approach to Clinical Practice Transformation
title_sort defining the value of analgesia for total knee arthroplasty using time-driven activity-based costing: a novel approach to clinical practice transformation
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8572874/
https://www.ncbi.nlm.nih.gov/pubmed/34765887
http://dx.doi.org/10.1016/j.mayocpiqo.2021.09.005
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