Total Hip Arthroplasty: ASCs in Tennessee
Study Methods
- 145 outpatient THAs in 125 patients performed with the use of EXPAREL by a single surgeon in 2 separate stand-alone ASCs
- Retrospective chart review
Safety Outcomes
- 1 recognized intraoperative fracture, which did not compromise same-day discharge
- 5 unanticipated complications (3.4%) in global period postsurgery
Clinical and Economic Outcomes
In patients who received EXPAREL to manage pain after surgery
Complication rates
compared favorably
with those reported
after standard
inpatient THA99.3%
of cases did not require a
transfer to the hospital
for transfusion- 0% of patients required other direct admissions to the hospital or ED
Average surgical time was
71 minutes
and total LOS was
10.8 hours98%
of cases did not require
surgical intervention
within a 90-day period- Persistent drainage 6 weeks postsurgery that required debridement/irrigation with head/liner exchange
- Periprosthetic fracture from a same-level fall at home 7 days postsurgery that required revision surgery
- Outpatient superficial wound revision, 4 weeks postsurgery
THA (N=145)
- Preoperative regimen
- Oral celecoxib 400 mg, gabapentin 300 mg, oxycodone 10 or 20 mg, and oral or intravenous acetaminophen 1000 mg
- Intraoperative regimen
- 0.75% bupivacaine with 8.25% dextrose 10 to 15 mg spinal, EXPAREL 266 mg infiltrated into wound, and intravenous dexamethasone 4 to 8 mg
- Postsurgical regimen
- Oral celecoxib 200 mg 4 times daily or meloxicam 7.5 mg 2 times daily, oral gabapentin 300 mg 2 times daily, oral tramadol 50 mg every 6 hours, oral acetaminophen 1000 mg every 8 hours, and oral oxycodone 5 to 10 mg every 4 to 6 hours as needed
- Spinal anesthesia was used in 132 procedures with bupivacaine (10.5-15 mg) and general endotracheal anesthesia was used in 13 patients due to previous spinal fusion, preexisting neuropathy, or intraoperative conversion secondary to unsuccessful spinal anesthesia
- Included 105 unilateral procedures and 20 bilateral procedures
*The clinical benefit of the decrease in opioid consumption was not demonstrated in the clinical trials.
ASC, ambulatory surgery center; ED, emergency department; LOS, length of stay; THA, total hip arthroplasty.
ASP, average sales price; CMS, Centers for Medicare and Medicaid Services.