Real-World Impact of Treatment with Liposomal Bupivacaine on Healthcare Resource Utilization, Opioid Consumption, and Cost Among Patients Undergoing Total Knee Arthroplasty in Ambulatory Surgical Settings in the United States.

Abstract

Perioperative pain management is critical to post-surgical recovery, as inadequate control can adversely affect patients for years. With the rise of total knee arthroplasty (TKA) in ambulatory surgical centers (ASCs), evaluating real-world strategies for postoperative analgesia has become increasingly important. The aims of this study were to (1) compare postoperative opioid use between patients receiving liposomal bupivacaine (LB) versus those who did not; (2) evaluate LB's effect on outpatient physical therapy visits and healthcare utilization; and (3) quantify differences in pain-related healthcare costs. Patients undergoing TKA in an outpatient ASC with moderate-to-high volume LB use between January 2019 and November 2022 were retrospectively identified from a national database. Patients were placed into two cohorts based on LB use on the TKA procedure date. Propensity score matching (PSM) with 1:1 matching created balanced cohorts. After PSM, each cohort comprised 2,307 patients (mean age of 69 years; 60.3% women). Opioid usage, all-cause and pain-related healthcare resource utilization (HCRU), and costs were examined over 30, 90, and 360 days post-surgery. On average, patients treated with LB had fewer opioid-treated days over 360 days post-surgery than those who did not have LB (35.2 versus 30.4; P < 0.05). Patients who had LB had fewer all-cause physical and occupational therapy (PT/OT) visits than patients who did not have LB over 30 (3.0 versus 3.5, P < 0.01), 90 (7.1 versus 8.1, P < 0.01), and 360 days (10.1 versus 11.6, P < 0.01) post-surgery, with consistent trends for pain-related PT/OT visits (all P < 0.01). Patients with LB incurred significantly lower total healthcare costs of $247, $438, and $1,318 less over 30, 90, and 360 days post-surgery, respectively, with similar trends for pain-related costs (all P < 0.05). Post-surgical LB analgesia was associated with fewer opioid-treated days and lower total HCRU and costs over one year following surgery. These results may further inform healthcare providers of the role of LB analgesia as part of multimodal pain management in improving post-surgical care following TKA in ASCs.