Reduced length of stay and hospitalization costs among inpatient hysterectomy patients with postoperative pain management including IV versus oral acetaminophen

PLoS One. 2018 Sep 13;13(9):e0203746. doi: 10.1371/journal.pone.0203746. eCollection 2018.


Objective: To compare the outcomes of hysterectomy patients who received standard pain management including IV acetaminophen (IV APAP) versus oral APAP.

Methods: We performed a retrospective analysis of the Premier Database (January 2012 to September 2015) comparing hysterectomy patients who received postoperative pain management including IV APAP to those who received oral APAP starting on the day of surgery and continuing up to the third post-operative day, with no exclusions based on additional pain management. We compared the groups on length of stay (LOS), hospitalization costs, and average daily morphine equivalent dose (MED). The quarterly rate of IV APAP use for all hospitalizations by hospital was used as an instrumental variable in two-stage least squares regressions also adjusting for patient demographics, clinical risk factors, and hospital characteristics.

Results: We identified 22,828 hysterectomy patients including 14,811 (65%) who had received IV APAP. Study subjects averaged 50 and 52 years of age, respectively in the IV APAP and oral APAP cohorts and were predominantly non-Hispanic Caucasians (≥60% in both cohorts). Instrumental variable models found IV APAP associated with 0.8 days shorter hospitalization (95% CI: -0.92 to -0.68, p<0.0001) and $2,449 lower hospitalization costs (95% CI: -$2,902 to -$1,996, p<0.0001). Average daily MED trended lower without statistical significance (-1.41 mg, 95% CI: -3.43 mg to 0.61 mg, p = 0.17).

Conclusions: Compared to oral APAP, managing post-hysterectomy pain with IV APAP is associated with shorter LOS and lower total hospitalization costs.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acetaminophen / administration & dosage*
  • Acetaminophen / adverse effects
  • Acetaminophen / economics
  • Administration, Intravenous
  • Administration, Oral
  • Analgesics, Non-Narcotic / administration & dosage*
  • Analgesics, Non-Narcotic / adverse effects
  • Analgesics, Non-Narcotic / economics
  • Databases, Factual
  • Female
  • Hospital Costs / statistics & numerical data*
  • Humans
  • Hysterectomy
  • Inpatients
  • Intestinal Diseases / etiology
  • Length of Stay / economics*
  • Logistic Models
  • Middle Aged
  • Pain, Postoperative / drug therapy*
  • Retrospective Studies
  • Uterine Diseases / surgery


  • Analgesics, Non-Narcotic
  • Acetaminophen

Grant support

This study was funded by Mallinckrodt Pharmaceuticals to RNH. The study funder was involved in study design, data acquisition, and review/approval of the final manuscript.