Background:
Epidural analgesia can be associated with high costs and postsurgical risks such as
hypotension, despite its widespread use and value in providing
opioid-sparing
pain management. We tested the hypothesis that liposomal
bupivacaine (LB) might be a reliable alternative to
epidural analgesia in this real-world study. Objectives: To compare economic outcomes and
hypotension incidence associated with use of LB and
epidural analgesia for abdominal surgery. Methods: This retrospective analysis identified records of adults who underwent abdominal surgeries between January 2016 and September 2019 with either LB administration or traditional
epidural analgesia using the Premier Healthcare Database. Economic outcomes included
length of stay, hospital costs, rates of discharge to home, and 30-day
hospital readmissions. Secondary outcomes included incidence of postsurgical
hypotension and vasopressor use. Subgroup analyses were stratified by
surgical procedure (colorectal, abdominal) and approach (endoscopic, open). A generalized linear model adjusted for patient and hospital characteristics was used for all comparisons. Results: A total of 5799 surgical records (LB, n=4820;
epidural analgesia, n=979) were included. Compared with cases where LB was administered, cases of
epidural analgesia use were associated with a 1.6-day increase in
length of stay (adjusted rate ratio [95% confidence interval (CI), 1.2 [1.2-1.3]]; P<.0001) and $6304 greater hospital costs (adjusted rate ratio [95% CI], 1.2 [1.2-1.3]]; P<.0001). Cost differences were largely driven by room-and-board fees.
Epidural analgesia was associated with reduced rates of discharge to home (P<.0001) and increased 30-day readmission rates (P=.0073) compared with LB.
Epidural analgesia was also associated with increased rates of postsurgical
hypotension (30% vs 11%; adjusted odds ratio [95% CI], 2.8 [2.3-3.4]; P<.0001) and vasopressor use (22% vs 7%; adjusted odds ratio [95% CI], 3.1 [2.5-4.0]; P<.0001) compared with LB. Subgroup analyses by
surgical procedure and approach were generally consistent with overall comparisons. Discussion: Our results are consistent with previous studies that demonstrated
epidural analgesia can be associated with higher utilization of healthcare resources and complications compared with LB. Conclusions: Compared with
epidural analgesia, LB was associated with economic benefits and reduced incidence of postsurgical
hypotension and vasopressor use.