Impact of liposomal bupivacaine on opioid use, hospital length of stay, discharge status, and hospitalization costs in patients undergoing total hip arthroplasty

Figures & data

Figure 1. Patient selection (inclusion/exclusion criteria). LB, liposomal bupivacaine; THA, total hip arthroplasty. *Patients insured through Medicaid or other sources were not included in the analyses due to the small sample size.

Table 1. Patient demographics and clinical characteristics.*

Characteristic	Medicare			Commercial Insurance
	With LB (n = 3,622)	Without LB (n = 3,610)	p-value	With LB (n = 2,648)	Without LB (n = 2,709)	p-value
Mean (SD) age, years	72.6 (8.1)	73.0 (8.1)	0.04	57.0 (7.9)	56.9 (7.8)	0.492
Age group, n (%), years			0.252			0.969
18–34	1 (0.0)	2 (0.1)		33 (1.3)	34 (1.3)
35–44	18 (0.5)	15 (0.4)		146 (5.5)	151 (5.6)
45–54	63 (1.7)	60 (1.7)		651 (24.6)	695 (25.7)
55–64	217 (6.0)	178 (4.9)		1,539 (58.1)	1,551 (57.3)
65–74	1,923 (53.1)	1,885 (52.2)		254 (9.6)	252 (9.3)
≥75	1,400 (38.7)	1,470 (40.7)		25 (0.9)	26 (1.0)
Women, n (%)	2,275 (62.8)	2,301 (63.7)	0.413	1,284 (48.5)	1,343 (49.6)	0.427
Race, n (%)			0.498			0.402
White	3,223 (89.0)	3,229 (89.5)		2,296 (86.7)	2,382 (87.9)
Black	191 (5.3)	196 (5.4)		205 (7.7)	189 (7.0)
Other	208 (5.7)	185 (5.1)		147 (5.6)	138 (5.1)
DCCI, n (%)			0.865			0.904
0	2,259 (62.4)	2,246 (62.2)		2,062 (77.9)	2,114 (78.0)
1	801 (22.1)	818 (22.7)		460 (17.4)	457 (16.9)
2	358 (9.9)	339 (9.4)		85 (3.2)	95 (3.5)
≥3	204 (5.6)	207 (5.7)		41 (1.6)	43 (1.6)
Admission source, n (%)			<0.001			0.038
Clinic	1,401 (38.7)	1,289 (35.7)		816 (30.8)	762 (28.1)
Referred by physician or self	2,186 (60.4)	2,249 (62.3)		1,820 (68.7)	1,918 (70.8)
SNF	1 (0.0)	12 (0.3)		1 (0.0)	3 (0.1)
Transfer from hospital	8 (0.2)	19 (0.5)		1 (0.0)	6 (0.2)
Other	26 (0.7)	41 (1.1)		10 (0.4)	20 (0.7)
Admission type, n (%)			<0.001			0.008
Elective	3,406 (94.0)	3,302 (91.5)		2,599 (98.2)	2,633 (97.2)
Emergency	158 (4.4)	200 (5.5)		18 (0.7)	38 (1.4)
Urgent	49 (1.4)	89 (2.5)		31 (1.2)	33 (1.2)
Other	9 (0.3)	19 (0.5)		0 (0.0)	5 (0.2)

Abbreviations: DCCI, Deyo-Charlson Comorbidity Index; LB, liposomal bupivacaine; SNF, skilled nursing facility.

*After propensity score matching.

Table 2. Univariate analyses of total opioid use, hospital LOS, discharge status, and total hospitalization costs.

Characteristic	Medicare			Commercial Insurance
	With LB (n = 3,622)	Without LB (n = 3,610)	p-value	With LB (n = 2,648)	Without LB (n = 2,709)	p-value
Mean (SD) total opioid use, mg MED	n = 3,561	n = 3,541		n = 2,591	n = 2,652
	244.2 (216.7)	319.9 (282.8)	<0.001	255.0 (200.1)	355.2 (334.0)	<0.001
LOS, 1 day	n = 754	n = 264		n = 913	n = 344
	151.1 (104.9)	123.9 (115.3)	<0.001	184.3 (134.2)	144.0 (114.5)	<0.001
LOS, 2 days	n = 1,406	n = 1,043		n = 1254	n = 1,240
	219.8 (153.1)	261.3 (224.5)	0.003	254.7 (180.2)	305.3 (281.7)	0.006
LOS, 3 days	n = 946	n = 1,480		n = 298	n = 842
	291.2 (253.1)	338.9 (277.8)	<0.001	368.1 (220.9)	438.4 (327.3)	0.006
LOS, 4 days	n = 214	n = 385		n = 72	n = 125
	320.3 (261.1)	376.9 (298.9)	0.036	433.1 (297.9)	525.5 (333.4)	0.081
Mean (SD) hospital LOS	n = 3,576	n = 3524		n = 2,626	n = 2,675
	2.4 (1.2)	2.9 (1.1)	<0.001	1.9 (0.9)	2.4 (0.9)	<0.001
Discharge status, n (%)	n = 3,622	n = 3,609	<0.001	n = 2,648	n = 2,709	<0.001
Home	2,559 (70.7)	2,179 (60.4)		2,477 (93.5)	2,450 (90.4)
SNF	851 (23.5)	1,153 (31.9)		109 (4.1)	166 (6.1)
Rehabilitation center	197 (5.4)	247 (6.8)		58 (2.2)	62 (2.3)
Other	9 (0.3)	26 (0.7)		3 (0.1)	30 (1.1)
Died	6 (0.2)	5 (0.1)		1 (0)	1 (0)
≥1 readmission, n (%)
30 days	n = 3,533	n = 3,561		n = 2,599	n = 2,679
	118 (3.3)	145 (4.1)	0.103	54 (2.1)	51 (1.9)	0.651
60 days	n = 3,511	n = 3,454		n = 2,538	n = 2,654
	188 (5.4)	214 (6.1)	0.243	103 (4.1)	96 (3.6)	0.408
90 days	n = 3,454	n = 3,383		n = 2,485	n = 2,614
	248 (7.3)	264 (7.6)	0.624	155 (6.2)	147 (5.6)	0.353
Mean (SD) total hospitalization costs, USD	n = 3,583	n = 3,544		n = 2,614	n = 2,618
	15,817 (4,661)	16,078 (5,289)	0.031	14,906 (3,979)	14,746 (4,495)	0.169

Abbreviations: LB, liposomal bupivacaine; LOS, length of stay; MED, oral morphine equivalent dose; SNF, skilled nursing facility; USD, US dollars.

Table 3. Multivariable analysis of total opioid consumption.

	Medicare				Commercial Insurance
Variable	Estimate	SE	p-value	Predicted difference	Estimate	SE	p-value	Predicted difference
Total opioid Consumption, mg
Intercept	6.23	0.04	<0.0001		6.40	0.04	<0.0001
With vs without LB	–0.29	0.02	<0.0001	–105	–0.20	0.03	<0.0001	–81
Age ≥65 vs <65 years*	–0.58	0.03	<0.0001	–217	–0.22	0.03	<0.0001	–90
Women vs men	0.03	0.02	0.0717	12	–0.17	0.03	<0.0001	–70
Race (vs white)
Black	0.02	0.04	0.6355	7	0.04	0.06	0.4575	23
Other	–0.09	0.04	0.0236	–31	–0.54	0.08	<0.0001	–204
DCCI (vs 0)
1	0.09	0.02	<0.0001	31	0.12	0.04	0.0042	49
2	0.13	0.03	<0.0001	46	0.09	0.09	0.2976	37
≥3	0.23	0.04	<0.0001	84	0.14	0.12	0.2529	57

Abbreviations: DCCI, Deyo-Charlson Comorbidity Index; LB, liposomal bupivacaine; LOS, length of stay.

*Age for commercial insurance, ≥55 vs <55 years.

Table 4. Multivariable analysis of hospital LOS, home discharge status, and total hospitalization costs.

	Medicare				Commercial Insurance
Variable	Estimate	SE	p-value	Predicted difference	Estimate	SE	p-value	Predicted difference
Hospital LOS, days
Intercept	0.96	0.02	<0.0001		0.78	0.01	<0.0001
With vs without LB	–0.22	0.01	<0.0001	–0.7	–0.25	0.01	<0.0001	–0.7
Age ≥65 vs <65 years*	0.02	0.02	0.4292	0	0.05	0.01	<0.0001	0.1
Women vs men	0.10	0.01	<0.0001	0.3	0.11	0.01	<0.0001	0.3
Race (vs white)
Black	0.06	0.03	0.0125	0.2	0.11	0.02	<0.0001	0.3
Other	–0.09	0.02	0.0003	–0.2	–0.17	0.03	<0.0001	–0.4
DCCI (vs 0)
1	0.12	0.01	<0.0001	0.3	0.08	0.02	<0.0001	0.2
2	0.28	0.02	<0.0001	0.8	0.21	0.03	<0.0001	0.5
≥3	0.53	0.02	<0.0001	1.7	0.57	0.05	<0.0001	1.6
Home discharge status
Intercept	1.64	0.20	<0.0001		3.72	0.24	<0.0001
With vs without LB	0.51	0.05	<0.0001	1.66	0.45	0.11	<0.0001	1.57
Age ≥65 vs <65 years*	–0.29	0.10	0.0057	0.75	–0.55	0.13	<0.0001	0.58
Women vs men	–0.78	0.06	<0.0001	0.46	–0.90	0.11	<0.0001	0.41
Race (vs white)
Black	–0.32	0.11	0.0054	0.73	–0.53	0.18	0.003	0.59
Other	–0.04	0.13	0.7424	0.96	–0.07	0.27	0.778	0.93
DCCI (vs 0)
1	–0.48	0.06	<0.0001	0.62	–0.59	0.12	<0.0001	0.55
2	–0.78	0.09	<0.0001	0.46	–0.94	0.22	<0.0001	0.39
≥3	–1.68	0.12	<0.0001	0.19	–2.35	0.25	<0.0001	0.10
Total hospitalization costs, USD
Intercept	9.70	0.02	<0.0001		9.60	0.01	<0.0001
With vs without LB	–0.03	0.01	<0.0001	–561	0.00	0.01	0.7697	41
Age ≥65 vs <65 years*	–0.02	0.02	0.1134	–419	0.01	0.01	0.5536	91
Women vs men	0.01	0.01	0.0869	247	0.02	0.01	0.0085	375
Race (vs white)
Black	–0.03	0.02	0.1029	–515	–0.04	0.02	0.0127	–690
Other	–0.06	0.02	0.0006	–1,055	–0.07	0.02	0.0003	–1,137
DCCI (vs 0)
1	0.05	0.01	<0.0001	825	0.04	0.01	0.0003	656
2	0.11	0.01	<0.0001	1,791	0.04	0.03	0.0994	619
≥3	0.25	0.02	<0.0001	4,423	0.20	0.04	<0.0001	3,189

Abbreviations: DCCI, Deyo-Charlson Comorbidity Index; LB, liposomal bupivacaine; LOS, length of stay; USD, US dollars.

*Age for commercial insurance, ≥55 vs <55 years.