Medicare Patients Use Less Opioids After EXPAREL: New Study

A new, as yet unpublished study of the use of EXPAREL (bupivacaine liposome injectable suspension) in 645 Medicare patients receiving primary inpatient large joint arthroplasty (337 total knees and 308 total hips) is reporting that the use of EXPAREL significantly reduced the need for post discharge opioid use.

Specifically, the study is reporting that most of the patients studied did not require more than a 7-day opioid prescription following discharge.

The study, unpublished as of yet, was a retrospective chart review data on 645 consecutive Medicare patients who underwent primary inpatient total knee arthroplasty (TKA) (337 patients) or THA (total hip arthroplasty) (308 patients) between June 1, 2015 and November 16, 2017. Key findings included:

• 84% of patients were same-day discharged to home, without home services, following their joint replacement
• 2% did not require any additional opioid prescriptions beyond the 7-day prescription provided at discharge
• Patients reported high satisfaction with their perioperative experience
• Comparable or lower complication rates to nationally reported rates

The study protocol included:

• Presurgical physical, medical, and social optimization
• Individualized multimodal pain management
• Patient and caregiver education before and after surgery

Co-author and orthopedic surgeon James Van Horne, M.D. of Paragon Orthopedic Center in Grants Pass, Oregon, performed all 645 surgeries and authored this analysis.

Asked about the challenges regarding stabilization of the modifiable risk factors and development of a social support network, Dr. Van Horne told OTW, “Initially, it was difficult to get patients on board, they expected the surgery alone would make them ‘all better’—a sad misconception that often leads to disappointment and poor outcomes. They expected 5-7 days in a hospital followed by 2-3 weeks in a SNF [skilled nursing facility]. Worse—they expected everyone else to do the work for them.”

“I learned that no matter how awesome a surgeon I was and how wonderful my program, if the patient was unwilling to take responsibility for their own recovery both before and after surgery, their results and satisfaction would be sub optimal.”

“In the early days I often felt I was beating my head against the immovable object of past history. I tried all types of joint classes, one-on-one education sessions and finally an education program that starts with their first visit.”

“For the last 3-5 years patients mostly come to me for the program with its low complication rates, high success and high patient satisfaction. For a surgeon initiating a program like mine, they will have to deal with a huge weight of historical baggage.”

“Patients will refuse to take responsibility for their health issues and health care. They want someone else to do all the work…Thousands of years of health providers telling the sick and infirm that ‘they’ (the health provider) will cure the patients’ problem(s)…Present societal belief that there are magic pills, diets or nostrums that will cure their problems…Primary Care and Specialist providers taking the path of least resistance.”

“Health care providers are tired of trying to get patients to change their habits. They are exhausted by patients’ refusal to exercise, eat better/less and reduce/stop tobacco/ETOH [alcohol]. Rather than fight the good fight anymore they just pile on another pill as the best alternative.”