scholarly journals Patterns of pre-operative opioid use affect the risk for complications after total joint replacement

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Bheeshma Ravi ◽  
Daniel Pincus ◽  
Ruth Croxford ◽  
Timothy Leroux ◽  
JMichael Paterson ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Total Joint Replacement ◽  
Surgical Complication ◽  
Revision Arthroplasty ◽  
Population Based ◽  
Joint Arthroplasty ◽  
Opioid Use ◽  
Increased Risk ◽  
Chronic Use ◽  
Ratio Matching

AbstractPreoperative opioid use has been shown to increase the risk for complications following total joint arthroplasty (TJA); however, these studies have not always accounted for differences in co-morbidities and socio-demographics between patients that use opioids and those that do not. They have also not accounted for the variation in degree of pre-operative use. The objective of this study was to determine if preoperative opioid use is associated with risk for surgical complications after TJA, and if this association varied by degree of use. Population-based retrospective cohort study. Older adult patients undergoing primary TJA of the hip, knee and shoulder for osteoarthritis between 2002 and 2015 in Ontario, Canada were identified. Using accepted definitions, patients were stratified into three groups according to their preoperative opioid use: no use, intermittent use and chronic use. The primary outcome was the occurrence of a composite surgical complication (surgical site infection, dislocation, revision arthroplasty) or death within a year of surgery. Intermittent and chronic users were matched separately to non-users in a 1:1 ratio, matching on TJA type plus a propensity score incorporating patient and provider factors. Overall, 108,067 patients were included in the study; 10% (N = 10,441) used opioids on a chronic basis before surgery and 35% (N = 37,668) used them intermittently. After matching, chronic pre-operative opioid use was associated with an increased risk for complications after TJA (HR 1.44, p = 0.001) relative to non-users. Overall, less than half of patients undergoing TJA used opioids in the year preceding surgery; the majority used them only intermittently. While chronic pre-operative opioid use is associated with an increased risk for complications after TJA, intermitted pre-operative use is not.

scholarly journals Patterns of pre-operative opioid use affect the risk for complications after total joint replacement

2021 ◽  
Author(s):  
Bheeshma Ravi ◽  
Daniel Pincus ◽  
Ruth Croxford ◽  
Timothy Leroux ◽  
Michael Paterson ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Total Joint Replacement ◽  
Surgical Complication ◽  
Revision Arthroplasty ◽  
Population Based ◽  
Joint Arthroplasty ◽  
Opioid Use ◽  
Increased Risk ◽  
Chronic Use ◽  
Ratio Matching

Abstract Background Preoperative opioid use has been shown to increase the risk for complications following total joint arthroplasty (TJA); however, these studies have not always accounted for differences in co-morbidities and socio-demographics between patients that use opioids and those that do not. They have also not accounted for the variation in degree of pre-operative use. The objective of this study was to determine if preoperative opioid use is associated with risk for surgical complications after TJA, and if this association varied by degree of use. Methods Population-based retrospective cohort study. Older adult patients undergoing primary TJA of the hip, knee and shoulder for osteoarthritis between 2002 and 2015 in Ontario, Canada were identified. Using accepted definitions, patients were stratified into three groups according to their preoperative opioid use: no use, intermittent use and chronic use. The primary outcome was the occurrence of a composite surgical complication (surgical site infection, dislocation, revision arthroplasty) or death within a year of surgery. Intermittent and chronic users were matched separately to non-users in a 1:1 ratio, matching on TJA type plus a propensity score incorporating patient and provider factors. Results Overall, 108,067 patients were included in the study; 10% (N=10,441) used opioids on a chronic basis before surgery and 35% (N=37,668) used them intermittently. After matching, neither intermittent nor chronic pre-operative opioid use were associated with an increased risk for complications after TJA. Conclusions Overall, less than half of patients undergoing TJA used opioids in the year preceding surgery; the majority used them only intermittently. Pre-operative opioid use is not associated with an increased risk for complications after TJA.

Prescription opioid use during pregnancy and risk for preterm birth or term low birthweight

2021 ◽  
Vol 17 (3) ◽  
pp. 215-225
Author(s):  
Julia D. Interrante, MPH ◽  
Stacey L. P. Scroggs, PhD ◽  
Carol J. Hogue, PhD ◽  
Jan M. Friedman, MD ◽  
Jennita Reefhuis, PhD ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Gestational Age ◽  
Low Birthweight ◽  
Opioid Analgesic ◽  
Population Based ◽  
Prescription Opioid ◽  
Opioid Use ◽  
Increased Risk ◽  
Potential Risks ◽  
Prescription Opioid Use

Objective: Examine the relationship between prescription opioid analgesic use during pregnancy and preterm birth or term low birthweight.Design, setting, and participants: We analyzed data from the National Birth Defects Prevention Study, a US multisite, population-based study, for births from 1997 to 2011. We defined exposure as self-reported prescription opioid use between one month before conception and the end of pregnancy, and we dichotomized opioid use duration by ≤7 days and 7 days.Main outcome measures: We examined the association between opioid use and preterm birth (defined as gestational age 37 weeks) and term low birthweight (defined as 2500 g at gestational age ≥37 weeks).Results: Among 10,491 singleton mother/infant pairs, 470 (4.5 percent) reported opioid use. Among women reporting opioid use, 236 (50 percent) used opioids for 7 days; codeine (170, 36 percent) and hydrocodone (163, 35 percent) were the most commonly reported opioids. Opioid use was associated with slightly increased risk for preterm birth [adjusted odds ratio, 1.4; 95 percent confidence interval, 1.0, 1.9], particularly with hydrocodone [1.6; 1.0, 2.6], meperidine [2.5; 1.2, 5.2], or morphine [3.0; 1.5, 6.1] use for any duration; however, opioid use was not significantly associated with term low birthweight.Conclusions: Preterm birth occurred more frequently among infants of women reporting prescription opioid use during pregnancy. However, we could not determine if these risks relate to the drug or to indications for use. Patients who use opioids during pregnancy should be counseled by their practitioners about this and other potential risks associated with opioid use in pregnancy. 

scholarly journals Methadone, Pierre Robin sequence and other congenital anomalies: case–control study

2019 ◽  
Vol 105 (2) ◽  
pp. 151-157
Author(s):  
Brian Cleary ◽  
Maria Loane ◽  
Marie-Claude Addor ◽  
Ingeborg Barisic ◽  
Hermien E K de Walle ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Congenital Anomalies ◽  
Population Based ◽  
Pierre Robin Sequence ◽  
Opioid Use ◽  
Robin Sequence ◽  
Risk Increase ◽  
Increased Risk ◽  
Pierre Robin ◽  
Control Study

ObjectiveMethadone is a vital treatment for women with opioid use disorder in pregnancy. Previous reports suggested an association between methadone exposure and Pierre Robin sequence (PRS), a rare craniofacial anomaly. We assessed the association between gestational methadone exposure and PRS.Design/settingThis case-malformed control study used European Surveillance of Congenital Anomalies population-based registries in Ireland, the Netherlands, Italy, Switzerland, Croatia, Malta, Portugal, Germany, Wales, Norway and Spain, 1995–2011.PatientsCases included PRS based on International Classification of Disease (ICD), Ninth Edition-British Paediatric Association (BPA) code 75 603 or ICD, Tenth Edition-BPA code Q8708. Malformed controls were all non-PRS anomalies, excluding genetic conditions, among live births, fetal deaths from 20 weeks’ gestation and terminations of pregnancy for fetal anomalies. An exploratory analysis assessed the association between methadone exposure and other congenital anomalies (CAs) excluding PRS. Methadone exposure was ascertained from medical records and maternal interview.ResultsAmong 87 979 CA registrations, there were 127 methadone-exposed pregnancies and 336 PRS cases. There was an association between methadone exposure and PRS (OR adjusted for registry 12.3, 95% CI 5.7 to 26.8). In absolute terms, this association reflects a risk increase from approximately 1–12 cases per 10 000 births. A raised OR was found for cleft palate (adjusted OR 5.0, 95% CI 2.7 to 9.2).ConclusionsThese findings suggest that gestational methadone exposure is associated with PRS. The association may be explained by unmeasured confounding factors. The small increased risk of PRS in itself does not alter the risk–benefit balance for gestational methadone use. The association with cleft palate, a more common CA, should be assessed with independent data.

Association between paediatric intraoperative anaesthesia handover and adverse postoperative outcomes

2020 ◽  
pp. bmjqs-2020-012298
Author(s):  
Thomas Kannampallil ◽  
Daphne Lew ◽  
Ethan E Pfeifer ◽  
Anshuman Sharma ◽  
Joanna Abraham
Keyword(s):  
Primary Outcome ◽  
Propensity Scores ◽  
Population Based ◽  
Postoperative Outcomes ◽  
Academic Medical Centre ◽  
Academic Medical ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Anaesthesia Care

ObjectiveTo determine whether intraoperative handover of patient care from one anaesthesia clinician to another was associated with an increased risk of adverse postoperative outcomes during paediatric surgeries.Design, setting and participantsA retrospective, population-based cohort study (1 April 2013–1 June 2018) at an academic medical centre.ExposureIntraoperative handover of care between pairs of anaesthesia clinicians from one care provider to another compared with no handover of anaesthesia care.Main outcomes and measuresThe primary outcome was a composite of all-cause mortality and major postoperative morbidity within 30 days after surgery. Secondary outcomes included individual components of the primary outcome and 30-day hospital readmission. Inverse probability of exposure weighting using propensity scores for intraoperative handovers was calculated. Weighted logistic regression was used to determine the association between intraoperative anaesthesia handovers and outcomes.Results78 321 paediatric surgical cases (n=5411 with handovers) were included for analysis. Patients were predominantly male (56.5%) with a median age of 6.56 (IQR: 2.65–12.53) years and a median anaesthesia duration of 76 (IQR: 55–126) min. In the weighted sample, the odds of the primary outcome (OR: 0.92; 95% CI 0.75 to 1.13; p=0.43), any morbidity (OR: 0.93; 95% CI 0.75 to 1.16; p=0.515), all-cause mortality (OR: 0.8; 95% CI 0.37 to 1.73; p=0.565) or 30-day readmission following surgery (OR: 0.99; 95% CI 0.84 to 1.18; p=0.95) did not significantly differ among surgeries with and without handovers.ConclusionsAmong paediatric patients undergoing surgery, intraoperative anaesthesia handovers were not associated with adverse postoperative outcomes, after accounting for relevant covariates. These findings provide a preliminary perspective on the role of intraoperative handovers as a care-neutral event, with implications for improving safety.

scholarly journals Comparison of Total Joint Replacement Rate Between Patients With Hemophilia A and Patients With Hemophilia B: A Population-Based and Retrospective Cohort Study

2018 ◽  
Vol 24 (9_suppl) ◽  
pp. 163S-170S
Author(s):  
Wen-Ya Lin ◽  
Jiaan-Der Wang ◽  
Yu-Tse Tsan ◽  
Wei-Cheng Chan ◽  
Kwok-Man Tong ◽  
...  
Keyword(s):  
Joint Replacement ◽  
Hemophilia A ◽  
Total Joint Replacement ◽  
Population Based ◽  
Hemophilia B ◽  
Clotting Factor ◽  
Research Database ◽  
Increased Risk ◽  
The Difference ◽  
Factor Concentrate

Recurrent hemarthrosis in patients with hemophilia (PWH) results in chronic arthropathy requiring total joint replacement (TJR). This study aimed to compare the difference in TJR rate between patients with hemophilia A (HA) and hemophilia B (HB). A final total of 935 PWH (782 HA and 153 HB) without inhibitors were collected from the Taiwan’s National Health Insurance Research Database between 1997 and 2013. Demographics, clinical characteristics, and TJR rate were compared between the 2 groups. The annual use of clotting factor concentrate was not different between HA and HB groups ( P = .116). The rate of comorbidities except for 29 PWH having HIV who were all in the HA group was also not different between the 2 groups. A total of 99 (10.6%) PWH had undergone 142 TJR procedures during the study period. All of them had received on-demand therapy. No difference was found in the cumulative incidence of TJR between HA and HB ( P = .787). After adjusting for various confounders including age, pyogenic arthritis, and HIV infection, no increased risk of TJR was found in patients with HA versus Patients with HB (hazard ratio: 0.92, 95% confidence interval 0.54-1.58). This finding suggests that the rate of TJR between patients with HA and HB is not significantly different.

scholarly journals Incident opioid drug use and adverse respiratory outcomes among older adults with COPD

2016 ◽  
Vol 48 (3) ◽  
pp. 683-693 ◽  
Author(s):  
Nicholas T. Vozoris ◽  
Xuesong Wang ◽  
Hadas D. Fischer ◽  
Chaim M. Bell ◽  
Denis E. O'Donnell ◽  
...  
Keyword(s):  
Older Adults ◽  
Emergency Room ◽  
Population Based ◽  
Chronic Obstructive ◽  
Emergency Room Visits ◽  
Opioid Use ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Respiratory Outcomes ◽  
Related Mortality

We evaluated risk of adverse respiratory outcomes associated with incident opioid use among older adults with chronic obstructive pulmonary diseases (COPD).This was a retrospective population-based cohort study using a validated algorithm applied to health administrative data to identify adults aged 66 years and older with COPD. Inverse probability of treatment weighting using the propensity score was used to estimate hazard ratios comparing adverse respiratory outcomes within 30 days of incident opioid use compared to controls.Incident opioid use was associated with significantly increased emergency room visits for COPD or pneumonia (HR 1.14, 95% CI 1.00–1.29; p=0.04), COPD or pneumonia-related mortality (HR 2.16, 95% CI 1.61–2.88; p<0.0001) and all-cause mortality (HR 1.76, 95% CI 1.57–1.98; p<0.0001), but significantly decreased outpatient exacerbations (HR 0.88, 95% CI 0.83–0.94; p=0.0002). Use of more potent opioid-only agents was associated with significantly increased outpatient exacerbations, emergency room visits and hospitalisations for COPD or pneumonia, and COPD or pneumonia-related and all-cause mortality.Incident opioid use, and in particular use of the generally more potent opioid-only agents, was associated with increased risk for adverse respiratory outcomes, including respiratory-related mortality, among older adults with COPD. Potential adverse respiratory outcomes should be considered when prescribing new opioids in this population.

scholarly journals Clinical and demographic covariates of chronic opioid and non-opioid analgesic use in rural-dwelling older adults: the MoVIES project

2013 ◽  
Vol 25 (11) ◽  
pp. 1801-1810 ◽  
Author(s):  
Jordan F. Karp ◽  
Ching-Wen Lee ◽  
Jonathan McGovern ◽  
Gary Stoehr ◽  
Chung-Chou H. Chang ◽  
...  
Keyword(s):  
Sleep Problems ◽  
Opioid Analgesic ◽  
Secondary Analysis ◽  
Opioid Analgesics ◽  
Epidemiological Data ◽  
Population Based ◽  
Opioid Use ◽  
Original Cohort ◽  
Analgesic Use ◽  
Chronic Use

ABSTRACTBackground:To describe covariates and patterns of late-life analgesic use in the rural, population-based MoVIES cohort from 1989 to 2002.Methods:Secondary analysis of epidemiologic survey of elderly people conducted over six biennial assessment waves. Potential covariates of analgesic use included age, gender, depression, sleep, arthritis, smoking, alcohol, and general health status. Of the original cohort of 1,681, this sample comprised 1,109 individuals with complete data on all assessments. Using trajectory analysis, participants were characterized as chronic or non-chronic users of opioid and non-opioid analgesics. Multivariable regression was used to model predictors of chronic analgesic use.Results:The cohort was followed for mean (SD) 7.3 (2.7) years. Chronic use of opioid analgesics was reported by 7.2%, while non-opioid use was reported by 46.1%. In the multivariable model, predictors of chronic use of both opioid and non-opioid analgesics included female sex, taking ≥2 prescription medications, and “arthritis” diagnoses. Chronic opioid use was also associated with age 75–84 years; chronic non-opioid use was also associated with sleep continuity disturbance.Conclusions:These epidemiological data confirm clinical observations and generate hypotheses for further testing. Future studies should investigate whether addressing sleep problems might lead to decreased use of non-opioid analgesics and possibly enhanced pain management.

scholarly journals Population-Based Study on the All-Cause and Cause-Specific Risks of Mortality among Long-Term Opioid Analgesics Users without Cancer in Taiwan

Healthcare ◽  
2021 ◽  
Vol 9 (11) ◽  
pp. 1402
Author(s):  
Po-Feng Lee ◽  
Chung-Yi Li ◽  
Yen-Chin Liu ◽  
Chang-Ta Chiu ◽  
Wen-Hsuan Hou
Keyword(s):  
General Population ◽  
Opioid Analgesics ◽  
Population Based ◽  
Opioid Use ◽  
Data Set ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Underlying Causes ◽  
Standardized Mortality Ratios

(1) Background: The prevalence of opioid use in Taiwan increased by 41% between 2002 and 2014. However, little is known regarding the risk of mortality among long-term opioid analgesics users who do not have cancer. This study investigated this mortality risk with an emphasis on the calendar year and patients’ age and sex. (2) Methods: This retrospective cohort study included 12,990 adult individuals without cancer who were long-term users of opioid analgesics and were randomly selected from the data set of Taiwan’s National Health Insurance program from 2000 to 2012. They were then followed up through 2013. Information on the underlying causes of death was retrieved from the Taiwan Death Registry. Age, sex, and calendar year-standardized mortality ratios (SMRs) of all-cause and cause-specific mortality were calculated with reference to those of the general population. (3) Results: With up to 14 years of follow-up, 558 individuals had all-cause mortality in 48,020 person-years (cumulative mortality: 4.3%, mortality rate: 11.62 per 1000 person-years). Compared with the general population, the all-cause SMR of 4.30 (95% confidence interval (95% CI): 3.95–4.66) was significantly higher: it was higher in men than in women, declined with calendar year and age, and was significantly higher for both natural (4.15, 95% CI: 3.78–4.53) and unnatural (5.04, 95% CI: 3.88–6.45) causes. (4) Conclusions: Long-term opioid analgesics use among individuals without cancer in Taiwan was associated with a significantly increased risk of mortality. The notably increased mortality in younger adults warrants attention. Strategies to reduce long-term opioid analgesics use, especially their overuse or misuse, are in an urgent need.

scholarly journals The association between statin and COVID-19 adverse outcomes: National COVID-19 cohort in South Korea

2021 ◽  
Author(s):  
Ronald Chow ◽  
Jihui Lee ◽  
Hyerim Noh ◽  
Jongseong Lee ◽  
Hyun Joon Shin ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Composite Endpoint ◽  
Population Based ◽  
Protective Role ◽  
Adverse Outcomes ◽  
Current Guideline ◽  
Cohort Entry ◽  
Healthcare Database ◽  
Outpatient Prescription ◽  
Increased Risk

Background: There currently exists limited and conflicting clinical data on the use of statins amongst COVID-19 patients. Given the both paucity and lack of consensus among data on statin's efficacy and safety amongst COVID-19 patients, the current guideline is to continue statin in COVID-19 patients, who have previously been treated with statins. The aim of this paper was to compare hospitalized patients with COVID-19 who did and did not receive statins, in terms of COVID-19 outcomes. Methods: We conducted population-based retrospective study using South Korea's nationwide healthcare database as of May 15 2020. We identified 4,349 patients hospitalized with COVID-19 and aged 40 years or older. The cohort entry was defined as the date of hospitalization. Statin users were individuals with inpatient and outpatient prescription records of statins in the 240 days before cohort entry, and non-users were those without such records during this period. Our primary outcome was a composite endpoint of all-cause death, intensive care unit (ICU) admission, mechanical ventilation use and cardiovascular outcomes (myocardial infarction (MI), transient cerebral ischemic attacks (TIA) or stroke). We conducted inverse probability of treatment weighting (IPTW)-adjusted logistic regression analysis to estimate odds ratio (OR) and corresponding 95% confidence intervals (CI), to compare outcomes between statin users and non-users. Findings: 1,115 patients were statin users (mean age = 65.9 years; 60% female), and 3,234 were non-users (mean age = 58.3 years; 64% female). Statin use was not associated with increased risk of the primary outcome (IPTW OR 0.82; 95% CI: 0.60-1.11). Subgroup analysis showed a protective role of statins, for individuals with hypertension (IPTW OR 0.40; 95% CI: 0.23-0.69, p for interaction: 0.0087). Interpretation: Given that statins are not detrimental and that it may be beneficial amongst hypertensive patients and relatively cheap, we would encourage further investigation into statin for the prevention and treatment of COVID-19.

scholarly journals Risk of Adverse Clinical Outcomes in Hyponatremic Adult Patients Hospitalized for Acute Medical Conditions: A Population-Based Cohort Study

2020 ◽  
Vol 105 (11) ◽  
Author(s):  
Alexander Kutz ◽  
Fahim Ebrahimi ◽  
Soheila Aghlmandi ◽  
Ulrich Wagner ◽  
Miluska Bromley ◽  
...  
Keyword(s):  
Cohort Study ◽  
Adverse Events ◽  
Hospital Mortality ◽  
Primary Outcome ◽  
Population Based ◽  
Control Group ◽  
Short Term ◽  
Patient Disposition ◽  
Increased Risk ◽  
Medical Inpatients

Abstract Context Hyponatremia has been associated with excess long-term morbidity and mortality. However, effects during hospitalization are poorly studied. Objective The objective of this work is to examine the association of hyponatremia with the risk of in-hospital mortality, 30-day readmission, and other short-term adverse events among medical inpatients. Design and Setting A population-based cohort study was conducted using a Swiss claims database of medical inpatients from January 2012 to December 2017 Patients Hyponatremic patients were 1:1 propensity-score matched with normonatremic medical inpatients. Main Outcome Measure The primary outcome was a composite of all-cause in-hospital mortality and 30-day hospital readmission. Secondary outcomes were intensive care unit (ICU) admission, intubation rate, length-of-hospital stay (LOS), and patient disposition after discharge. Results After matching, 94 352 patients were included in the cohort. Among 47 176 patients with hyponatremia, 8383 (17.8%) reached the primary outcome compared with 7994 (17.0%) in the matched control group (odds ratio [OR] 1.06 [95% CI, 1.02-1.10], P = .001). Hyponatremic patients were more likely to be admitted to the ICU (OR 1.43 [95% CI, 1.37-1.50], P &lt; .001), faced a 56% increase in prolonged LOS (95% CI, 1.52-1.60, P &lt; .001), and were admitted more often to a postacute care facility (OR 1.38 [95% CI 1.34-1.42, P &lt; .001). Of note, patients with the syndrome of inappropriate antidiuresis (SIAD) had lower in-hospital mortality (OR 0.67 [95% CI, 0.56-0.80], P &lt; .001) as compared with matched normonatremic controls. Conclusion In this study, hyponatremia was associated with increased risk of short-term adverse events, primarily driven by higher readmission rates, which was consistent among all outcomes except for decreased in-hospital mortality in SIAD patients.

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