Total Joint Arthroplasty Study1,2: Medicare and Commercial
Background
Two studies analyzed the impact that EXPAREL, as part of an ERAS pathway, had on same-day discharge. The Medicare-focused study analyzed the outcome and feasibility of same-day discharge using an ERAS protocol in the inpatient setting, while the commercial insurance-focused study analyzed outcomes in an ASC.
- Medicare: Orthopedic center in Oregon
- Commercial: ASC in Oregon
Study Methods
- Medicare and Commercial: Retrospective chart review
- Medicare: 601 unique patients who underwent primary TKA (n=337) or THA (n=308) with the use of EXPAREL
- Commercial: 220 unique patients who underwent primary TKA (n=113) or THA (n=138) with the use of EXPAREL in a freestanding ASC
Safety Outcomes
- Medicare: Within 30 days after surgery, 1.1% of patients experienced a severe AE and 0.5% of patients experienced a minor AE
- Commercial: Within 30 days after surgery, 6 patients experienced a severe AE and 1 patient experienced a minor AE
Clinical and Economic Outcomes
In patients who received EXPAREL for analgesia
Same-day discharge
Medicare
- 84% of patients were discharged on the day of surgery
Commercial
- 100% of patients were discharged on the day of surgery
High pain management satisfaction
Medicare
- 98.3% of patients were “very much” or a “good amount” satisfied with pain management
Commercial
- 99.3% of patients were “very much” or a “good amount” satisfied with pain management
Postsurgical opioid use
Medicare
- 84.2% of patients did not require an opioid prescription beyond the initial 7-day prescription provided at discharge*
TJA: MEDICARE (N=601) AND COMMERCIAL (N=220)
- Individualized preoperative opioid analgesia protocol
- Non-opioid analgesia protocol consisting of acetaminophen, meloxicam, or celecoxib utilized 1 week before surgery and for 6 weeks after surgery
- Spinal anesthesia
- Periarticular infiltration with EXPAREL 266 mg, bupivacaine HCl, and adjuncts
- Restricted intravenous opioids during surgery
THA: MEDICARE (n=308) AND COMMERCIAL (n=138)
- Anterior lateral femoral cutaneous nerve field block with EXPAREL 266 mg and bupivacaine HCl
TKA: MEDICARE (n=337) AND COMMERCIAL (n=113)
- Adductor canal block with bupivacaine HCl
*The clinical benefit of the decrease in opioid consumption was not demonstrated in pivotal trials.
AE, adverse event; ASC, ambulatory surgery center; ERAS, enhanced recovery after surgery; THA, total hip arthroplasty; TJA, total joint arthroplasty; TKA, total knee arthroplasty.