Four-Corner Arthrodesis versus Proximal Row Carpectomy: Risk Factors and Complications Associated with Prolonged Postoperative Opioid Use

2020 ◽  
Author(s):  
Neill Y. Li ◽  
Alexander S. Kuczmarski ◽  
Andrew M. Hresko ◽  
Avi D. Goodman ◽  
Joseph A. Gil ◽  
...  
Keyword(s):  
Risk Factors ◽  
International Classification Of Diseases ◽  
Opioid Use ◽  
Proximal Row Carpectomy ◽  
Use Patterns ◽  
Patient Demographics ◽  
Implant Complications ◽  
Increased Risk ◽  
Classification Of Diseases

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.

Readmission after Adult Uvulopalatopharyngoplasty: A Population-Based Inpatient Cohort Study in Taiwan

2018 ◽  
Vol 160 (3) ◽  
pp. 559-566 ◽  
Author(s):  
Ying-Shuo Hsu ◽  
Wei-Chung Hsu ◽  
Jenq-Yuh Ko ◽  
Te-Huei Yeh ◽  
Chia-Hsuan Lee ◽  
...  
Keyword(s):  
Odds Ratio ◽  
International Classification Of Diseases ◽  
Population Based ◽  
Factors Associated ◽  
Risk Of Bleeding ◽  
Increased Risk ◽  
Classification Of Diseases ◽  
Insurance Database ◽  
Population Based Survey

Objective To investigate readmissions among adult inpatients who underwent uvulopalatopharyngoplasty (UPPP) in Taiwan. Design Population-based survey. Setting Retrospective study with the National Health Insurance Database. Methods All cases of inpatient adult UPPP (age >20 years) from 1997 to 2012 were identified through International Classification of Diseases, Ninth Revision, Clinical Modification. Factors associated with readmission within 30 days after surgery were analyzed. Results A total of 38,839 adults with UPPP were identified (mean age, 39.3 years; men, 73.7%). The incidence of UPPP was 14.6 per 100 000 adults, which increased from 1997 to 2012 (6.7 to 16.7 per 100,000, Ptrend < .001). The rates of readmission for any reason, readmission for bleeding, reoperation for bleeding, and 30-day mortality were 4.2%, 1.7%, 1.0%, and 0.14%, respectively. Young age increased the risk of reoperation for bleeding, and old age increased the risk of readmission for any reason and mortality. Men had an increased risk of readmission and reoperation. Hypertension was associated with an increased risk of readmission for any reason (odds ratio [OR], 1.29; 95% CI, 1.10-1.51), bleeding-related readmission (OR, 1.89; 95% CI, 1.52-2.36), and reoperation (OR, 2.47; 95% CI, 1.84-3.30). Concurrent hypopharyngeal surgery was associated with an increased risk of readmission for any reason (OR, 1.34; 95% CI, 1.07-1.66) and bleeding-related readmission (OR, 1.69; 95% CI, 1.25-2.27). Finally, the use of steroids was associated with an increased risk of bleeding-related readmission and reoperation. Conclusions The incidence of adult UPPP increased from 1997 to 2012 in Taiwan. Age, sex, comorbidity, concurrent hypopharyngeal surgery, and drug administration were associated with readmission after inpatient UPPP.

scholarly journals Insomnia is associated with an increased risk of type 2 diabetes in the clinical setting

2018 ◽  
Vol 6 (1) ◽  
pp. e000604 ◽  
Author(s):  
Erin S LeBlanc ◽  
Ning X Smith ◽  
Gregory A Nichols ◽  
Michael J Allison ◽  
Gregory N Clarke
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Clinical Setting ◽  
Clinical Importance ◽  
International Classification Of Diseases ◽  
Hospital Inpatient ◽  
Increased Risk ◽  
Traditional Risk Factors

ObjectiveTo determine the possible association between insomnia and risk of type 2 diabetes mellitus (T2DM) in the naturalistic clinical setting.Research design and methodsWe conducted a retrospective cohort study to examine the risk of developing T2DM among patients with pre-diabetes with and without insomnia. Participants with pre-diabetes (identified by a physician or via two laboratory tests) between January 1, 2007 and December 31, 2015 and without sleep apnea were followed until December 31, 2016. Patients were determined to have T2DM when two of the following occurred within a 2-year window: physician-entered outpatient T2DM diagnosis (International Classification of Diseases [ICD]-9 250.00; ICD-10 E11), dispensing of an antihyperglycemia agent, and hemoglobin A1c (A1c) >6.5% (48 mmol/mol) or fasting plasma glucose (FPG) >125 mg/dL. One hospital inpatient stay with an associated T2DM diagnosis was also sufficient for classification of T2DM.ResultsOur cohort consisted of 81 233 persons with pre-diabetes, 24 146 (29.7%) of whom had insomnia at some point during the 4.3-year average observation period. After adjustment for traditional risk factors, those with insomnia were 28% more likely to develop T2DM than those without insomnia (HR 1.28; 95% CI 1.24 to 1.33). The estimate was essentially unchanged after adjusting for baseline A1c level (HR 1.32; 95% CI 1.25 to 1.40) or FPG (HR 1.28; 95% CI 1.23 to 1.33).ConclusionsInsomnia imparts an increased risk of T2DM comparable with that conferred by traditional risk factors (eg, overweight, non-white race, cardiovascular risk factors). This association could have clinical importance because it suggests a new potentially modifiable risk factor that could be targeted to prevent diabetes.

scholarly journals Clinical burden of severe respiratory syncytial virus infection during the first 2 years of life in children born between 2000 and 2011 in Scotland

2020 ◽  
Vol 179 (5) ◽  
pp. 791-799 ◽  
Author(s):  
Richard Thwaites ◽  
Scot Buchan ◽  
John Fullarton ◽  
Carole Morris ◽  
ElizaBeth Grubb ◽  
...  
Keyword(s):  
Respiratory Syncytial Virus ◽  
Neuromuscular Disorders ◽  
International Classification Of Diseases ◽  
National Data ◽  
Clinical Burden ◽  
Increased Risk ◽  
Classification Of Diseases ◽  
Bed Days ◽  
Syncytial Virus

AbstractNational data from Scotland (all births from 2000 to 2011) were used to estimate the burden associated with respiratory syncytial virus hospitalisation (RSVH) during the first 2 years of life. RSVHs were identified using the International Classification of Diseases 10th Revision codes. Of 623,770 children, 13,362 (2.1%) had ≥ 1 RSVH by 2 years, with the overall rate being 27.2/1000 (16,946 total RSVHs). Median age at first RSVH was 137 days (interquartile range [IQR] 62–264), with 84.3% of admissions occurring by 1 year. Median length of stay was 2 (IQR 1–4) days and intensive care unit (ICU) admission was required by 4.3% (727) for a median 5 (IQR 2–8) days. RSVHs accounted for 6.9% (5089/73,525) of ICU bed days and 6.2% (64,395/1,033,121) of overall bed days (5370/year). RSVHs represented 8.5% (14,243/168,205) of all admissions between October and March and 14.2% (8470/59,535) between December and January. RSVH incidence ranged from 1.7 to 2.5%/year over the study period. Preterms (RSVH incidence 5.2%), and those with congenital heart disease (10.5%), congenital lung disease (11.2%), Down syndrome (14.8%), cerebral palsy (15.5%), cystic fibrosis (12.6%), and neuromuscular disorders (17.0%) were at increased risk of RSVH.Conclusions: RSV causes a substantial burden on Scottish paediatric services during the winter months.What is known:• Respiratory syncytial virus (RSV) is a leading cause of childhood hospitalisation.What is new:• This 12-year study is the first to estimate the burden of RSV hospitalisation (RSVH) in Scotland and included all live births from 2000 to 2011 and followed > 600,000 children until 2 years old.• The overall RSVH rate was 27.2/1000 children, with 2.1% being hospitalised ≥ 1 times.• RSVHs accounted for 6.2% of all inpatient bed days, which rose to 14.2% during the peak months of the RSV season (December–January), equating to over 1400 hospitalisations and nearly 5500 bed days each year.

scholarly journals Hospitalization-Based Major Comorbidity of Inflammatory Bowel Disease in Canada

2007 ◽  
Vol 21 (8) ◽  
pp. 507-511 ◽  
Author(s):  
Charles N Bernstein ◽  
Alice Nabalamba
Keyword(s):  
Inflammatory Bowel Disease ◽  
Colon Cancer ◽  
Bowel Disease ◽  
International Classification Of Diseases ◽  
International Classification ◽  
Increased Risk ◽  
Classification Of Diseases ◽  
Inflammatory Bowel ◽  
Hodgkin's Lymphomas

OBJECTIVE: To define the patterns of hospitalization for known major comorbidities associated with inflammatory bowel disease (IBD) in Canada.METHODS: The data source was the Statistics Canada Health Person Oriented Information hospital database (1994/1995 to 2003/2004). The number of stays for a diagnosis of Crohn’s disease or ulcerative colitis by theInternational Classification of Diseases, ninth edition, codes 555 or 556, or theInternational Classification of Diseases, 10th edition, Canadian Enhancement, codes K50 or K51, was extracted. Age- and sex-specific and age-adjusted rates of hospitalization for selected IBD-related comorbidities were assessed.RESULTS: Rates of Hodgkin’s disease and non-Hodgkin’s lymphoma were low in the hospitalized IBD population. Rates for colon cancer, rectal cancer, pulmonary emboli and deep venous thromboembolism were generally higher among IBD patients younger than 50 years of age compared with the non-IBD hospitalized population.CONCLUSIONS: IBD was associated with life-threatening comorbidities such as venous thromboembolic disease and colon cancer among persons younger than 50 years of age to a greater extent than the general hospitalized population. Recent secular trends in rates of non-Hodgkin’s lymphomas will need to be followed to determine whether the whole population, including IBD patients who receive immunomodulating therapies, are at increased risk.

Major Factors Associated with Congenital Malformations in the Agadir Region of Morocco

2020 ◽  
Vol 3 (8) ◽  
Author(s):  
SAID EL MADIDI
Keyword(s):  
Risk Factors ◽  
Congenital Malformations ◽  
International Classification Of Diseases ◽  
The Body ◽  
Explanatory Variables ◽  
Classification Of Diseases ◽  
History Of ◽  
Major Factors

Introduction: Congenital malformations are a global health problem around the world. MCs is one of the main causes of death and disability of newborns worldwide, but the majority of its risk factors are still poorly understood. Objective: The aim of this study is to determine the main causes that are related to the incidence of congenital malformations (CMs) in the region of Agadir in Morocco. Material and Methods: A prospective cases-control study at regional level was conducted in the pediatrics and neonatology department of Hassan II hospital in Agadir from April 2016 to April 2018. Data on child and maternal variables were recorded for 3701 newborns. The types of congenital malformations  have been classified according to the codes of the International Classification of Diseases. Univariate analyzes were performed to identify the variables associated with the etiology of the malformations. Multiple logistic regression was used to characterize the associations between the MC and the determining explanatory variables taken into account simultaneously. Results: The results of these studies showed that there is a significant association between the incidence of the Congenital anomalies and the level of the consanguinity of the child, the prematurity of childbirth, the family history of CMs, the body mass index of the mother and the presence of major trauma during pregnancy. Conclusion: our results have made it possible to highlight the existence of an association between a certain number of risk factors and the occurrence of congenital malformations. Additional studies are needed to confirm and clarify the role of these risk factors.

Impact of opioid use disorders on outcomes and readmission following cardiac operations

Heart ◽  
2020 ◽  
pp. heartjnl-2020-317618
Author(s):  
Josef Madrigal ◽  
Yas Sanaiha ◽  
Joseph Hadaya ◽  
Puneet Dhawan ◽  
Peyman Benharash
Keyword(s):  
Artery Bypass ◽  
International Classification Of Diseases ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Classification Of Diseases ◽  
Multivariable Regression ◽  
Multivariable Adjustment ◽  
Income Quartile ◽  
Cardiac Operations

ObjectiveWhile opioid use disorder (OUD) has been previously associated with increased morbidity and resource use in cardiac operations, its impact on readmissions is understudied.MethodsPatients undergoing coronary artery bypass grafting and valve repair or replacement, excluding infective endocarditis, were identified in the 2010–16 Nationwide Readmissions Database. Using International Classification of Diseases 9/10, we tabulated OUD and other characteristics. Multivariable regression was used to adjust for differences.ResultsOf an estimated 1 978 276 patients who had cardiac surgery, 5707 (0.3%) had OUD. During the study period, the prevalence of OUD increased threefold (0.15% in 2010 vs 0.53% in 2016, parametric trend<0.001). Patients with OUD were more likely to be younger (54.0 vs 66.0 years, p<0.001), insured by Medicaid (28.2 vs 6.2%, p<0.001) and of the lowest income quartile (33.6 vs 27.1%, p<0.001). After multivariable adjustment, OUD was associated with decreased mortality (1.5 vs 2.7%, p=0.001). Although these patients had similar rates of overall complications (36.1 vs 35.1%, p=0.363), they had increased thromboembolic (1.3 vs 0.8%, p<0.001) and infectious (4.1 vs 2.8%, p<0.001) events, as well as readmission at 30 days (19.0 vs 13.2%, p<0.001). While patients with OUD had similar hospitalisation costs ($50 766 vs $50 759, p=0.994), they did have longer hospitalisations (11.4 vs 10.3 days, p<0.001).ConclusionThe prevalence of OUD among cardiac surgical patients has steeply increased over the past decade. Although the presence of OUD was not associated with excess mortality at index hospitalisation, it was predictive of 30-day readmission. Increased attention to predischarge interventions and care coordination may improve outcomes in this population.

Risk factors and classification of stillbirth in a Middle Eastern population: a retrospective study

2018 ◽  
Vol 46 (9) ◽  
pp. 1022-1027 ◽  
Author(s):  
Mariam Kunjachen Maducolil ◽  
Hafsa Abid ◽  
Rachael Marian Lobo ◽  
Ambreen Qayyum Chughtai ◽  
Arjumand Muhammad Afzal ◽  
...  
Keyword(s):  
Risk Factors ◽  
Middle Eastern ◽  
International Classification Of Diseases ◽  
Population Based ◽  
Eastern Population ◽  
Medical Disorders ◽  
Classification Of Diseases ◽  
Middle Eastern Population ◽  
Multiethnic Population

AbstractObjective:To estimate the incidence of stillbirth, explore the associated maternal and fetal factors and to evaluate the most appropriate classification of stillbirth for a multiethnic population.Methods:This is a retrospective population-based study of stillbirth in a large tertiary unit. Data of each stillbirth with a gestational age >/=24 weeks in the year 2015 were collected from electronic medical records and analyzed.Results:The stillbirth rate for our multiethnic population is 7.81 per 1000 births. Maternal medical factors comprised 52.4% in which the rates of hypertensive disorders, diabetes and other medical disorders were 22.5%, 20.8% and 8.3%, respectively. The most common fetal factor was intrauterine growth restriction (IUGR) (22.5%) followed by congenital anomalies (21.6%). All cases were categorized using the Wigglesworth, Aberdeen, Tulip, ReCoDe and International Classification of Diseases-perinatal mortality (ICD-PM) classifications and the rates of unclassified stillbirths were 59.2%, 46.6%, 16.6%, 11.6% and 7.5%, respectively. An autopsy was performed in 9.1% of cases reflecting local religious and cultural sensitivities.Conclusion:This study highlighted the modifiable risk factors among the Middle Eastern population. The most appropriate classification was the ICD-PM. The low rates of autopsy prevented a detailed evaluation of stillbirths, therefore it is suggested that a minimally invasive autopsy [postmortem magnetic resonance imaging (MRI)] may improve the quality of care.

Arteriovenous access does not perform as well for plasmapheresis

2017 ◽  
Vol 18 (2) ◽  
pp. 144-147
Author(s):  
Mathew Wooster ◽  
Rachel Wilson ◽  
Murray Shames ◽  
Neil Moudgill
Keyword(s):  
International Classification Of Diseases ◽  
Primary Patency ◽  
Secondary Patency ◽  
Patient Demographics ◽  
Surgical Access ◽  
Classification Of Diseases ◽  
Maturation Rate ◽  
Arteriovenous Access ◽  
Stiff Man Syndrome

Purpose Access surgeons are occasionally asked to create arteriovenous access for non-dialysis functions. Subjectively noting overall poor results, we seek to present our experience with arteriovenous access creation for apheresis. Methods Billing records were reviewed using Current Procedural Terminology (CPT) and International Classification of Diseases (ICD-9) codes to identify patients undergoing arteriovenous access creation for diseases other than renal failure from January 2007 to August 2014. Inpatient and outpatient records were reviewed to identify patient demographics, disease-specific medications/treatments, access-specific characteristics, patency data, and reinterventions required. Results A total of 16 access creation procedures were performed for 8 patients, accounting for just 1.6% of total access creations during the period. Treatment was for myasthenia gravis (n = 6), chronic inflammatory degenerative polyneuropathy (n = 9), and stiff man syndrome (n = 1). Access failure was by thrombosis (n = 7), non-maturation (n = 4), and infection/steal syndrome (n = 1), with four accesses still functional at conclusion of review. There was 50% autogenous access creation and overall maturation rate of 37.5%. Mean primary patency was 236 days (range 10-878), with secondary patency achieved in three patients adding a mean of 174 days (range 2-517). Cumulative 3-month and 1-year patency rates were 36.5% and 25%, respectively. Conclusions Arteriovenous access creation for plasmapheresis represents a minority of access procedures. Though it remains unclear why, patency and maturation rates are significantly lower than expected when compared to access for hemodialysis access. These high failure rates must be taken into account when considering replacement of temporary catheters with surgical access for non-hemodialysis needs.

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