Retrospective analysis of quality improvement when using liposome bupivacaine for postoperative pain control

Figures & data

Table 1 Current procedural terminology (CPT^®) codes used to identify patients who underwent laparotomy, sternotomy, or thoracotomy at Naval Medical Center San Diego

Code	Description
Laparotomy
38747	Radical lymphadenectomy (radical resection of lymph nodes)
43300	Repair procedures on the esophagus
43611	Excision procedures on the stomach
44140	Excision procedures on the intestines (except rectum)
44143	Excision procedures on the intestines (except rectum)
44146	Excision procedures on the intestines (except rectum)
44156	Excision procedures on the intestines (except rectum)
44204	Laparoscopic excision procedures on the intestines (except rectum)
44212	Laparoscopic excision procedures on the intestines (except rectum)
44625	Repair procedures on the intestines (except rectum)
45110	Excision procedures on the rectum
45550	Repair procedures on the rectum
47563	Laparoscopic procedures on the biliary tract
48140	Excision procedures on the pancreas
48153	Excision procedures on the pancreas
49000	Incision procedures on the abdomen, peritoneum, and omentum
51860	Repair of bladder wound
53240	Excision procedures on the urethra
58200	Hysterectomy procedures
58247	Removal of pelvis contents
58953	Excision procedures on the ovary
58954	Excision procedures on the ovary
58956	Excision procedures on the ovary
Sternotomy
21825	Fracture and/or dislocation procedures on the neck (soft tissues) and thorax
33300	Surgical procedures on the heart (including valves) and great vessels
33335	Insertion of major vessel graft
33365	Aortic valve replacement
33405	Surgical procedures on the aortic valve
33425	Surgical procedures on the mitral valve
33426	Surgical procedures on the mitral valve
33430	Surgical procedures on the mitral valve
33465	Surgical procedures on the tricuspid valve
33510	Coronary artery bypass graft
33533	Arterial grafting for coronary artery bypass
33730	Repair procedures for venous anomalies
33863	Repair procedures for thoracic aortic aneurysm
33864	Repair procedures for thoracic aortic aneurysm
39220	Excision/resection procedures on the mediasternum
Thoracotomy
21620	Excision procedures on the neck (soft tissues) and thorax
32096	Incision procedures on the lungs and pleura (open wedge)
32097	Incision procedures on the lungs and pleura (open wedge and biopsy)
32100	Incision procedures on the lungs and pleura (chest exploration)
32110	Incision procedures on the lungs and pleura (chest exploration and repair)
32141	Incision procedures on the lungs and pleura (remove bullae)
32480	Removal procedures on the lungs and pleura
32608	Thoracoscopy (VATS) on the lungs and pleura
32654	Thoracoscopy (VATS) on the lungs and pleura
32666	Thoracoscopy (VATS) on the lungs and pleura

Notes: CPT copyright 2014, American Medical Association. All rights reserved.⁴¹

Abbreviation: VATS, video-assisted thoracic surgery.

Table 2 Demographic and baseline clinical characteristics

Characteristic	Pre-liposome bupivacaine (n=88)	Post-liposome bupivacaine (n=94)
Mean age, years (SD)
Overall population	54 (18)	55 (16)
Laparotomya	50 (18)	56 (16)
CTE	50 (17)	60 (15)
No CTE	50 (20)	55 (17)
Sternotomyb	62 (12)	58 (13)
Thoracotomyc	55 (22)	45 (20)
Male sex, n (%)
Overall population	52 (59)	48 (51)
Laparotomya	25 (48)	16 (33)
CTE	9 (36)	3 (19)
No CTE	16 (64)	13 (81)
Sternotomyb	19 (73)	23 (74)
Thoracotomyc	8 (80)	9 (64)
ASA physical status classification, mean (SD)
Overall population	2.6 (0.7)	2.7 (0.7)
Laparotomya	2.4 (0.7)	2.6 (0.7)
CTE	2.5 (0.5)	2.6 (0.5)
No CTE	2.4 (0.7)	2.6 (0.8)
Sternotomyb	3.2 (0.4)	2.9 (0.6)
Thoracotomyc	2.4 (0.7)	2.3 (0.6)
Preoperative pain score, mean (SD)
Overall population	2.0 (2.9)	0.7 (1.9)d
Laparotomy	2.8 (3.3)	1.3 (2.5)e
CTE	1.6 (2.4)	2.9 (3.4)
No CTE	3.5 (3.5)	0.8 (2.0)
Sternotomy	0.9 (1.8)	0e
Thoracotomy	0.6 (1.9)	0.4 (1.3)
Preoperative NRS pain intensity score ≥7, n (%)	9 (10)	2 (2)

Notes:

a Data shown are based on subgroups: n=52 for the pre-liposome bupivacaine group and n=49 for the post-liposome bupivacaine group.

b Data shown are based on subgroups: n=26 for the pre-liposome bupivacaine group and n=31 for the post-liposome bupivacaine group.

c Data shown are based on subgroups: n=10 for the pre-liposome bupivacaine group and n=14 for the post-liposome bupivacaine group.

d P=0.001 vs pre-liposome bupivacaine group.

e P<0.01 vs pre-liposome bupivacaine group.

Abbreviations: ASA, American Society of Anesthesiologists; CTE, continuous thoracic epidural; NRS, numerical rating scale; SD, standard deviation.

Table 3 Results for subgroups stratified by type of surgery

Parameter	Laparotomy		Sternotomy		Thoracotomy
	Pre-liposome bupivacaine(n=52)	Post-liposome bupivacaine(n=49)	Pre-liposome bupivacaine(n=26)	Post-liposome bupivacaine(n=31)	Pre-liposome bupivacaine(n=10a)	Post-liposome bupivacaine(n=14)
Mean pain intensity score	2.2	2.4	2.3	2.1	2.5	2.3
Mean maximum pain intensity score	7.0	6.4	7.2	5.7b	6.7	6.4
Mean total amount of orally administered postsurgical opioids (milligram morphine equivalents)	345	232	192	254	268	394
Number of patients admitted to ICU, n (%)	18 (35)	19 (39)	26 (100)	30 (97)	10 (100)	10 (71)
Mean length of ICU stay (days)	1.0	0.8	3.8	3.3	1.7	2.1
Mean length of hospital stay (days)	7.4	5.8b	6.6	6.0	6.0	5.1

Notes:

a Patients received continuous infusion of local anesthetic via elastomeric pump.

b P<0.05 vs pre-liposome bupivacaine group.

Abbreviation: ICU, intensive care unit.

Table 4 Results for subset analyses of patients who underwent laparotomy

Parameter	Laparotomy
	Pre-liposome bupivacaine, CTE(n=18)	Pre-liposome bupivacaine, No CTE(n=34)	Post-liposome bupivacaine, CTE only(n=11)	Post-liposome bupivacaine, liposome bupivacaine only(n=38)
Mean pain intensity score	1.6	2.6a	2.4	2.5
Mean maximum pain intensity score	6.2	7.4	7.1	6.2
Mean total amount of orally administered postsurgical opioids (milligram morphine equivalents)	242	400	226	234
Mean length of ICU stay (days)	1.7	0.7b	1.5	0.6c
Mean length of hospital stay (days)	8.9	6.6d	7.7e	5.3f

Notes:

a P=0.037 vs laparotomy pre-liposome bupivacaine CTE group.

b P=0.04 vs laparotomy pre-liposome bupivacaine CTE group.

c P=0.02 vs laparotomy post-liposome bupivacaine CTE only group.

d P=0.03 vs laparotomy pre-liposome bupivacaine CTE group.

e P=0.028 vs laparotomy pre-liposome bupivacaine CTE group.

f P=0.03 vs laparotomy post-liposome bupivacaine CTE only group.

Abbreviations: CTE, continuous thoracic epidural; ICU, intensive care unit.

CPT^® codesAmerican Medical Association Available from: http://coder.aapc.com/cpt-codes/Accessed April 4, 2016

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