JOA - 2026-06-01 - Journal Article
Real-World Impact of Treatment With Liposomal Bupivacaine on Health Care Resource Utilization, Opioid Consumption, and Cost Among Patients Undergoing Total Knee Arthroplasty in Ambulatory Surgical Settings in the United States.
Lin JH, Huo T, Pandya S, Mont MA, Ng MK, Wong G, Zhou Z, DeKoven M, DiGiorgi M, Pizzicato L
Topics
Key Takeaway
Liposomal bupivacaine use in outpatient TKA was associated with 4.8 fewer opioid-treated days and $1,318 lower total healthcare costs over 360 days compared to matched controls.
Summary Depth
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Summary
This study compared postoperative opioid consumption, PT/OT utilization, and healthcare costs between ASC TKA patients receiving liposomal bupivacaine (LB) versus those who did not, using propensity score-matched cohorts drawn from a national database (2019–2022). LB patients had fewer opioid-treated days at 360 days (30.4 vs. 35.2, P<0.05) and fewer PT/OT visits at all time points (10.1 vs. 11.6 at 360 days, P<0.01). Total healthcare cost savings with LB were $247, $438, and $1,318 at 30, 90, and 360 days respectively.
Key Limitation
The database design precludes knowledge of the specific multimodal analgesia protocol used alongside LB, meaning the observed benefits may reflect protocol-level differences between high-LB-use centers rather than LB itself.
Original Abstract
BACKGROUND
Perioperative pain management is critical to postsurgical recovery, as inadequate control can adversely affect patients for years. With the rise of total knee arthroplasty (TKA) in ambulatory surgery centers (ASCs), evaluating real-world strategies for postoperative analgesia has become increasingly important. The aims of this study were to (1) compare postoperative opioid use between patients receiving liposomal bupivacaine (LB) versus those who did not; (2) evaluate LB's effect on outpatient physical therapy visits and health care utilization; and (3) quantify differences in pain-related health care costs.
METHODS
Patients undergoing TKA in an outpatient ASC with moderate-to-high volume LB use between January 2019 and November 2022 were retrospectively identified from a national database. Patients were placed into two cohorts based on LB use on the TKA procedure date. Propensity score matching (PSM) with 1:1 matching created balanced cohorts. After PSM, each cohort comprised 2,307 patients (mean age of 69 years; 60.3% women). Opioid usage, all-cause and pain-related health care resource utilization (HCRU), and costs were examined over 30, 90, and 360 days postsurgery.
RESULTS
On average, patients treated with LB had fewer opioid-treated days over 360 days postsurgery than those who did not have LB (35.2 versus 30.4; P < 0.05). Patients who had LB had fewer all-cause physical and occupational therapy (PT/OT) visits than patients who did not have LB over 30 (3.0 versus 3.5, P < 0.01), 90 (7.1 versus 8.1, P < 0.01), and 360 days (10.1 versus 11.6, P < 0.01) postsurgery, with consistent trends for pain-related PT/OT visits (all P < 0.01). Patients with LB incurred significantly lower total health care costs of $247, $438, and $1,318 less over 30, 90, and 360 days postsurgery, respectively, with similar trends for pain-related costs (all P < 0.05).
CONCLUSIONS
Postsurgical LB analgesia was associated with fewer opioid-treated days and lower total HCRU and costs over one year after surgery. These results may further inform health care providers of the role of LB analgesia as part of multimodal pain management in improving postsurgical care following TKA in ASCs.