“A Cost Minimization Analysis Evaluating the Use of Liposomal Bupivacaine in Reconstructive Plastic Surgery Procedures.”

Postsurgical pain management is critical to patient satisfaction and value. Several studies have evaluated liposomal bupivacaine (LB) in postoperative pain management protocols, however its economic feasibility remains undefined. This study analyzes the economic impact of LB using a national claims database to assess postoperative clinical and financial outcomes in plastic and reconstructive procedures. Methods: The Vizient Clinical Database/Resource Manager™ electronic database was reviewed for plastic surgery procedures (abdominoplasty, abdominal wall reconstruction, mastectomy with immediate tissue expander placement, mastectomy with direct-to-implant reconstruction, autologous breast reconstruction, and augmentation mammoplasty) at participating hospitals from July 1, 2016-July 1, 2017. The main outcome measures were the length of stay (LOS), 7-, 14-, and 30-day readmission rates, and direct and total costs observed. Results: During the study period, 958 total cases met inclusion criteria. LB was used in 239 (25%) cases. Compared to cases that did not utilize LB, LB cases had a decreased LOS (9.2 days vs. 5.8 days), decreased cost (total cost $39,531 vs. $28,021, direct cost $23,960 vs. $17,561), and lower 30-day readmission rates 4% vs. 0%. The 14- and 7-day readmission rates were similar between the two groups. Conclusion: The use of LB may contribute to a reduction in LOS, hospital costs, and 30-day readmission rates for abdominal and breast reconstructive procedures, which could contribute to a favorable economic profile from a system view. Focusing on the measurement and improvement of value in the context of whole, definable, patient processes will be important as we transition to value-based payments. Disclosures: Dr. Janis is has served a prior consultant for Pacira Pharmaceuticals, LifeCell, Bard, Daiichi Sankyo, and Allergan within the last 12 months, but has no active affiliations. He receives royalties from Thieme Publishing. Dr. Janis Keller and Ramshaw have received consulting fees and speaker fees from Pacira Pharmaceuticals, which produces and sells liposomal bupivacaine (Exparel). Drs Little and Brower have nothing to disclose. No funding was received for this article. Corresponding Author: Jeffrey E. Janis, MD, FACS, Professor of Plastic Surgery, Neurosurgery, Neurology, and Surgery, Department of Plastic Surgery, The Ohio State University Wexner Medical Center, 915 Olentangy River Rd, Columbus, OH 43212, Phone: (614) 293-8566, Fax: (614) 293-9024, Email: jeffrey.janis@osumc.edu ©2019American Society of Plastic Surgeons

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