Efficacy of Intravenous Acetaminophen as Adjunct Post-Operative Analgesic in Cardiac Surgery: A Retrospective Study

Introduction. The dose-dependent adverse events associated with post-operative opioid use may be reduced when opioids are used in conjunction with intravenous acetaminophen. The purpose of this study was to compare outcomes in median sternotomy patients receiving intravenous acetaminophen in addition to intravenous opioids versus intravenous opioids only. Methods. A retrospective study was conducted on 122 adult patients undergoing median sternotomy at a regional tertiary-referral center. Data collected included patient demographics, length of stay, opioid and intravenous acetaminophen use, adverse effects, and transition time to oral pain medication. Results. There was no difference between groups in demographics, preoperative risk scores, operative procedures, intravenous opioid consumption, transition time to oral pain medications, or length of stay. Acetaminophen use was associated with lower rates of atrial fibrillation (7.0% vs. 24.6%, p = 0.009) and nausea/vomiting (8.9% vs. 32.3%, p = 0.002), but higher rates of urinary retention (15.8% vs. 3.1%, p = 0.014), constipation (50.0% vs. 20.0%, p = 0.001) and respiratory depression (7.1% vs. 0.0%, p = 0.043). Conclusion. Intravenous acetaminophen was not associated with a reduction in length of stay or opioid consumption, but was associated with lower rates of atrial fibrillation, nausea, and vomiting. Additional studies are needed to determine if intravenous acetaminophen administration reduces atrial fibrillation in this population

Rural-Urban Differences in Esophagectomy for Cancer

Introduction. Patients who are socioeconomically disadvantaged or in rural areas may not pursue surgery at high-volume centers, where outcomes are better for some complex procedures. The objective of this study was to determine and compare rural and urban patient differences and outcomes after undergoing esophagectomy for cancer. Methods. An analysis of the Healthcare Cost and Utilization Project National Inpatient Sample (HCUP NIS) database was performed, capturing adult patients with esophageal cancer who underwent esophagectomy. Patients were stratified into rural or urban groups by the National Center for Health Statistics Urban-Rural Classification Scheme. Demographics, hospital variables, and outcomes were compared. Results. A total of 2,877 patients undergoing esophagectomy for esophageal cancer were captured by the database, with 228 (7.92%) rural and 2,575 (89.50%) urban patients. The rural and urban groups had no difference in age, race, insurance status, and many common comorbidities. Major outcomes of mortality and length of stay were similar for both rural and urban patients (3.95% versus 4.27%, p=0.815) and (15.75±13.22 versus 15.55±14.91 days, p=0.828), respectively. There was a trend for rural patients to be more likely to discharge home (35.96% versus 29.79%, OR 0.667 [95%CI 0.479-0.929]; p=0.0167). Conclusions. This retrospective administrative database study indicates that rural and urban patients receive equivalent postoperative care after undergoing esophagectomy. The findings are reassuring as there does not appear to be a disparity in major outcomes depending on the location of residence, but further studies are necessary to assure equitable treatment for rural patients