Risk Factors for Opioid Use after Patellofemoral Stabilization Surgery: Analyses of 1,316 Cases

Abstract Introduction This article compares opioid use patterns following four-corner arthrodesis (FCA) and proximal row carpectomy (PRC) and identifies risk factors and complications associated with prolonged opioid consumption. Materials and Methods The PearlDiver Research Program was used to identify patients undergoing primary FCA (Current Procedural Terminology [CPT] codes 25820, 25825) or PRC (CPT 25215) from 2007 to 2017. Patient demographics, comorbidities, perioperative opioid use, and postoperative complications were assessed. Opioids were identified through generic drug codes while complications were defined by International Classification of Diseases, Ninth and Tenth Revisions, Clinical Modification codes. Multivariable logistic regressions were performed with p < 0.05 considered statistically significant. Results A total of 888 patients underwent FCA and 835 underwent PRC. Three months postoperatively, more FCA patients (18.0%) continued to use opioids than PRC patients (14.7%) (p = 0.033). Preoperative opioid use was the strongest risk factor for prolonged opioid use for both FCA (odds ratio [OR]: 4.91; p < 0.001) and PRC (OR: 6.33; p < 0.001). Prolonged opioid use was associated with an increased risk of implant complications (OR: 4.96; p < 0.001) and conversion to total wrist arthrodesis (OR: 3.55; p < 0.001) following FCA. Conclusion Prolonged postoperative opioid use is more frequent in patients undergoing FCA than PRC. Understanding the prevalence, risk factors, and complications associated with prolonged postoperative opioid use after these procedures may help physicians counsel patients and implement opioid minimization strategies preoperatively.

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Persistent Opioid Use After Ophthalmic Surgery in Opioid-Naive Patients and Associated Risk Factors

Ophthalmology ◽

10.1016/j.ophtha.2021.04.021 ◽

2021 ◽

Author(s):

Cindy Ung ◽

Yoshihiro Yonekawa ◽

Jennifer F. Waljee ◽

Vidhya Gunaseelan ◽

Yenling Lai ◽

...

Keyword(s):

Risk Factors ◽

Opioid Use ◽

Ophthalmic Surgery ◽

Associated Risk Factors

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New Persistent Opioid Use and Associated Risk Factors Following Treatment of Ankle Fractures

Foot & Ankle International ◽

10.1177/1071100719851117 ◽

2019 ◽

Vol 40 (9) ◽

pp. 1043-1051 ◽

Cited By ~ 5

Author(s):

Timothy D. Gossett ◽

Fred T. Finney ◽

Hsou Mei Hu ◽

Jennifer F. Waljee ◽

Chad M. Brummett ◽

...

Keyword(s):

Risk Factors ◽

Surgical Treatment ◽

Ankle Fracture ◽

Opioid Use ◽

Patient Factors ◽

Distal Fibula ◽

Opioid Prescription ◽

Opioid Dose ◽

Closed Treatment ◽

Open Treatment

Background:The aim of this study was to define the rate of new persistent opioid use and risk factors for persistent opioid use after operative and nonoperative treatment of ankle fractures.Methods:Using a nationwide insurance claims database, Clinformatics DataMart Database, we identified opioid-naïve patients who underwent surgical treatment of unstable ankle fracture patterns between January 2009 and June 2016. Patients who underwent closed treatment of a distal fibula fracture served as a comparative group. We evaluated peritreatment and posttreatment opioid prescription fills. The primary outcome, new persistent opioid use, was defined as opioid prescription fulfillment between 91 and 180 days after the procedure. Logistic regression was used to evaluate the effect of patient factors, and the differences of the effect were tested using Wald statistics. The adjusted persistent use rates were calculated. A total of 13 088 patients underwent treatment of an ankle fracture and filled a peritreatment opioid prescription.Results:When compared with closed treatment of a distal fibula fracture, only 2 surgical treatment subtypes demonstrated significantly increased rates of persistent use compared with the closed treatment group: open treatment of bimalleolar ankle fracture (adjusted odds ratio [aOR], 1.32; 95% CI, 1.10-1.58; P = .002) and open treatment of trimalleolar ankle fracture with fixation of posterior lip (aOR, 1.47; 95% CI, 1.04-2.07; P = .027). Rates were significantly increased (aOR, 1.56; 95% CI, 1.34-1.82; P < .001) among patients who received a total peritreatment opioid dose that was in the top 25th percentile of total oral morphine equivalents. Factors independently associated with new persistent opioid use included mental health disorders, comorbid conditions, tobacco use, and female sex.Conclusion:All ankle fracture treatment groups demonstrated high rates of new persistent opioid use, and persistent use was not directly linked to injury severity. Instead, we identified patient factors that demonstrated increased risk of persistent opioid use. Limiting the peritreatment opioid dose was the largest modifiable risk factor related to new persistent opioid use in this privately insured cohort.Level of Evidence:Level III, retrospective cohort study.

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Combating escalating harms associated with pharmaceutical opioid use in Australia: the POPPY II study protocol

BMJ Open ◽

10.1136/bmjopen-2018-025840 ◽

2018 ◽

Vol 8 (12) ◽

pp. e025840 ◽

Cited By ~ 5

Author(s):

Natasa Gisev ◽

Sallie-Anne Pearson ◽

Timothy Dobbins ◽

David C Currow ◽

Fiona Blyth ◽

...

Keyword(s):

Risk Factors ◽

Opioid Dependence ◽

Service Use ◽

Population Level ◽

Ethics Committee ◽

Adverse Outcomes ◽

Opioid Use ◽

Research Committee ◽

Services Research ◽

Wide Range

IntroductionOpioid prescribing has increased 15-fold in Australia in the past two decades, alongside increases in a range of opioid-related harms such as opioid dependence and overdose. However, despite concerns about increasing opioid use, extramedical use and harms, there is a lack of population-level evidence about the drivers of long-term prescribed opioid use, dependence, overdose and other harms.Methods and analysisWe will form a cohort of all adult residents in New South Wales (NSW), Australia, who initiated prescribed opioids from 2002 using Pharmaceutical Benefits Scheme dispensing records. This cohort will be linked to a wide range of other datasets containing information on sociodemographic and clinical characteristics, health service use and adverse outcomes (eg, opioid dependence and non-fatal and fatal overdose). Analyses will initially examine patterns and predictors of prescribed opioid use and then apply regression and survival analysis to quantify the risks and risk factors of adverse outcomes associated with prescribed opioid use.Ethics and disseminationThis study has received full ethical approval from the Australian Institute of Health and Welfare Ethics Committee, the NSW Population and Health Services Research Committee and the ACT Health Human Research Ethics Committee. This will be the largest postmarketing surveillance study of prescribed opioids undertaken in Australia, linking exposure and outcomes and examining risk factors for adverse outcomes of prescribed opioids. As such, this work has important translational promise, with direct relevance to regulatory authorities and agencies worldwide. Project findings will be disseminated at scientific conferences and in peer-reviewed journals. We will also conduct targeted dissemination with policy makers, professional bodies and peak bodies in the pain, medicine and addiction fields through stakeholder workshops and advisory groups. Results will be reported in accordance with the REporting of studies Conducted using Observational Routinely collected Data (RECORD) Statement.

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Patients’ risk factors for periprosthetic joint infection in primary total hip arthroplasty: a meta-analysis of 40 studies

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04647-1 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Xiaolei Ren ◽

Lin Ling ◽

Lin Qi ◽

Zhongyue Liu ◽

Wenchao Zhang ◽

...

Keyword(s):

Risk Factors ◽

Femoral Neck ◽

Femoral Neck Fracture ◽

Meta Analysis ◽

Joint Infection ◽

Female Gender ◽

Opioid Use ◽

Related Risk ◽

Modifiable Factors ◽

Neck Fracture

Abstract Background Periprosthetic joint infection (PJI) is a catastrophic complication after total hip arthroplasty (THA). Our meta-analysis aimed to identify the individual-related risk factors that predispose patients to PJI following primary THA. Methods Comprehensive literature retrieval from Pubmed, Web of Science, and the Cochrane Library was performed from inception to Feb 20th, 2021. Patient-related risk factors were compared as per the modifiable factors (BMI, smoke and alcohol abuse), non-modifiable factors (gender, age), and medical history characteristics, such as diabetes mellitus (DM), avascular necrosis (AVN) of femoral head, femoral neck fracture, rheumatoid arthritis (RA), cardiovascular disease (CVD), and osteoarthritis (OA) etc. The meta-analysis was applied by using risk ratios with 95% corresponding intervals. Sensitivity analysis and publication bias were performed to further assess the credibility of the results. Results Overall, 40 studies with 3,561,446 hips were enrolled in our study. By implementing cumulative meta-analysis, higher BMI was found associated with markedly increased PJI risk after primary THA [2.40 (2.01–2.85)]. Meanwhile, medical characteristics including DM [1.64 (1.25–2.21)], AVN [1.65 (1.07–2.56)], femoral neck fracture [1.75 (1.39–2.20)], RA [1.37 (1.23–1.54)], CVD [1.34 (1.03–1.74)], chronic pulmonary disease (CPD) [1.22 (1.08–1.37)], neurological disease [1.19 (1.05–1.35)], opioid use [1.53 (1.35–1.73)] and iron-deficiency anemia (IDA) [1.15 (1.13–1.17)] were also significantly correlated with higher rate of PJI. Conversely, dysplasia or dislocation [0.65 (0.45–0.93)], and OA [0.70 (0.62–0.79)] were protective factors. Of Note, female gender was protective for PJI only after longer follow-up. Besides, age, smoking, alcohol abuse, previous joint surgery, renal disease, hypertension, cancer, steroid use and liver disease were not closely related with PJI risk. Conclusion Our finding suggested that the individual-related risk factors for PJI after primary THA included high BMI, DM, AVN, femoral neck fracture, RA, CVD, CPD, neurological disease, opioid use and IDA, while protective factors were female gender, dysplasia/ dislocation and OA.

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A Vulnerability Assessment for a Future HIV Outbreak Associated With Injection Drug Use in Illinois, 2017–2018

Frontiers in Sociology ◽

10.3389/fsoc.2021.652672 ◽

2021 ◽

Vol 6 ◽

Author(s):

Cara Jane Bergo ◽

Jennifer R. Epstein ◽

Stacey Hoferka ◽

Marynia Aniela Kolak ◽

Mai T. Pho

Keyword(s):

Risk Factors ◽

High Risk ◽

Drug Use ◽

Injection Drug Use ◽

Negative Binomial ◽

Cook County ◽

Injection Drug ◽

County Level ◽

Opioid Use ◽

Zip Code

The current opioid crisis and the increase in injection drug use (IDU) have led to outbreaks of HIV in communities across the country. These outbreaks have prompted country and statewide examination into identifying factors to determine areas at risk of a future HIV outbreak. Based on methodology used in a prior nationwide county-level analysis by the US Centers for Disease Control and Prevention (CDC), we examined Illinois at the ZIP code level (n = 1,383). Combined acute and chronic hepatitis C virus (HCV) infection among persons <40 years of age was used as an outcome proxy measure for IDU. Local and statewide data sources were used to identify variables that are potentially predictive of high risk for HIV/HCV transmission that fell within three main groups: health outcomes, access/resources, and the social/economic/physical environment. A multivariable negative binomial regression was performed with population as an offset. The vulnerability score for each ZIP code was created using the final regression model that consisted of 11 factors, six risk factors, and five protective factors. ZIP codes identified with the highest vulnerability ranking (top 10%) were distributed across the state yet focused in the rural southern region. The most populous county, Cook County, had only one vulnerable ZIP code. This analysis reveals more areas vulnerable to future outbreaks compared to past national analyses and provides more precise indications of vulnerability at the ZIP code level. The ability to assess the risk at sub-county level allows local jurisdictions to more finely tune surveillance and preventive measures and target activities in these high-risk areas. The final model contained a mix of protective and risk factors revealing a heightened level of complexity underlying the relationship between characteristics that impact HCV risk. Following this analysis, Illinois prioritized recommendations to include increasing access to harm reduction services, specifically sterile syringe services, naloxone access, infectious disease screening and increased linkage to care for HCV and opioid use disorder.

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Risk Factors for Prolonged Postoperative Opioid Use After Spinal Fusion for Adolescent Idiopathic Scoliosis

Journal of Pediatric Orthopaedics ◽

10.1097/bpo.0000000000001177 ◽

2019 ◽

Vol 39 (9) ◽

pp. e729

Author(s):

Mark C. Kendall ◽

Lucas J. Castro Alves

Keyword(s):

Risk Factors ◽

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Spinal Fusion ◽

Opioid Use

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Reasons for Prescription Opioid Use While Playing in the National Football League as Risk Factors for Current Use and Misuse Among Former Players

Clinical Journal of Sport Medicine ◽

10.1097/jsm.0000000000000628 ◽

2018 ◽

Vol Publish Ahead of Print ◽

Cited By ~ 2

Author(s):

Eugene M. Dunne ◽

Catherine W. Striley ◽

Zachary L. Mannes ◽

Breton M. Asken ◽

Nicole Ennis (formerly Whitehead) ◽

...

Keyword(s):

Risk Factors ◽

National Football League ◽

Prescription Opioid ◽

Opioid Use ◽

Prescription Opioid Use

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Risk Factors for Opioid Use Following Anterior Cruciate Ligament Reconstruction (ACLR) in a Cohort of 21,202 ACLR

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00257 ◽

2019 ◽

Vol 7 (7_suppl5) ◽

pp. 2325967119S0025

Author(s):

Anita G. Rao ◽

Heather A. Prentice ◽

Priscilla Hannah Chan ◽

Liz W. Paxton ◽

Tadashi Ted Funahashi ◽

...

Keyword(s):

Risk Factors ◽

Substance Abuse ◽

Pulmonary Disease ◽

Chronic Pulmonary Disease ◽

Meniscal Injury ◽

Opioid Use ◽

Opioid Medication ◽

Factors Associated ◽

Asa Classification

Objectives: The misuse of opioid medication has contributed to a significant national crisis affecting public health, as well as patient morbidity and medical costs. We sought to determine baseline opioid utilization in patients undergoing ACLR and examine demographic, patient characteristics, and medical factors associated with postoperative opioid utilization. Methods: Primary elective ACLR were identified using an integrated healthcare system’s ACLR registry (January 2005-January 2015). Patients with cancer or those who had other knee surgery in the preceding year were excluded. We studied the effect of preoperative and intraoperative risks factors on number of dispensed opioid medication prescriptions (Rx) in the early (0-90 days) and late (91-360 days) postoperative periods using logit regression. Risk factors studied included: number of opioid Rx in preceding year, age, gender, race, American Society of Anesthesiologists (ASA) classification, body mass index (BMI), activity at the time of injury, time from injury to ACLR, concomitant procedure or injury, medical comorbidities, and opioid-use comorbidities. Results: Of 21202 ACLR from 20813 patients, 25.5% used at least 1 opioid Rx in the one-year preoperative period. 17.7% and 2.7% used ≥2 opioid Rx in the early and late recovery periods, respectively. The risk factors associated with greater opioid Rx in both the early and late periods included: preoperative opioid use, age >20 years, ASA classification of ≥3, other activity at the time of injury, repaired cartilage injury, chronic pulmonary disease, and substance abuse. Risk factors associated with opioid Rx use during the early period only included: other race, acute ACL injury, repaired meniscal injury, multi-ligament injury, and dementia/psychoses. Risk factors associated with greater opioid Rx during the late period included: female gender, BMI >25 kg/m2, motor vehicle accident as the mechanism of injury, and hypertension. Conclusion: We identified several risk factors for postoperative opioid usage after ACLR. The strongest predictors of postoperative prescription opioid usage after ACLR included preoperative opioid use, increasing age, ASA classification of 3 or more, other activity at the time of injury, repaired meniscal injury, cartilage repair, chronic pulmonary disease, and substance abuse. Awareness of risk factors for postoperative opioid usage may encourage more targeted utilization of opioids in pain management. Surgeons may consider additional support or referral to a pain specialist for patients with these risk factors. [Figure: see text]

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315. Prenatal Hepatitis C Viral (HCV) Screening Practices and HCV-Associated Fetal, Neonatal and Pregnancy Outcomes in a Large Regional Healthcare System

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.388 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S167-S167

Author(s):

Tripti Adhikari ◽

Rachel Scott ◽

Utsav Timalsina ◽

Ariunzaya Amgalan ◽

Shari L Sawney ◽

...

Keyword(s):

Risk Factors ◽

Prenatal Care ◽

Pregnant Women ◽

Behavioral Health ◽

Healthcare System ◽

Categorical Variables ◽

Opioid Use ◽

Screening Practices ◽

Hcv Screening ◽

In Pregnancy

Abstract Background Prevalence of HCV in pregnancy is 0.1–3.6%. AASLD and IDSA now recommend HCV screening in pregnancy although CDC, USPSTF, or ACOG still do not—though HCV can be perinatally transmitted and carries associated complications for the mother and fetus. Our study objectives were to analyze prenatal HCV screening practices at a large regional healthcare system and the prevalence of HCV-associated maternal and fetal/neonatal outcomes. Methods We performed a nested propensity score (PS) case–control study of pregnant women who tested HCV Ab+ in a cross-sectional study of women presenting for prenatal care at a large regional healthcare system from January 17 to December 18. We collected retrospective EHR data, including state of residency, HCV Ab, RNA, care engagement, HCV risk factors, comorbidities, maternal and fetal/neonatal morbidity, and neonatal HCV testing (when available). Mixed and generalized linear models were used to examine differences in continuous and categorical variables, respectively, between cases and controls Results 14,363 women were seen for prenatal care; 4,891 (34%) were HCV tested, 75 (1.5%) tested HCV Ab+. Demographic and comorbidity data are shown in Table 1. HCV Ab+ cases had more co-morbidities, including obesity, heart disease, opioid use, and behavioral health issues compared with the controls. HCV risk factors included IVDU (64%) and tattoos (24%) (Figure 1). Neither past/current pregnancy-related complications nor fetal or neonatal adverse events (Figure 2) were statistically significantly different except for cholestasis in HCV Ab+ cases (5.3 vs. 0%, P = 0.04). Conclusion Our study showed only one-third of pregnant women are currently HCV screened in our health system. Universal screening would likely increase the number of HCV-infected women identified. Early HCV detection, repeated testing, and behavioral health intervention of those at high-risk may decrease further horizontal and vertical transmission of HCV in pregnancy. Disclosures All authors: No reported disclosures.

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