scholarly journals Increased Risk of Postthoracotomy Pain Syndrome in Patients with Prolonged Hospitalization and Increased Postoperative Opioid Use

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Michelle A. O. Kinney ◽  
Adam K. Jacob ◽  
Melissa A. Passe ◽  
Carlos B. Mantilla
Keyword(s):  
Epidural Analgesia ◽  
Hospital Stay ◽  
Oral Morphine ◽  
Pain Syndrome ◽  
Pain Clinic ◽  
Opioid Use ◽  
Postthoracotomy Pain ◽  
Increased Risk ◽  
Prolonged Hospital ◽  
Postoperative Epidural Analgesia

Background. Postthoracotomy pain syndrome (PTPS) is unfortunately very common following thoracotomy and results in decreased quality of life. The purpose of this retrospective study was to determine perioperative patient, surgical, and analgesic characteristics associated with the development of PTPS. Methods. Sixty-six patients who presented to the Mayo Clinic Rochester Pain Clinic were diagnosed with PTPS 2 months or more after thoracotomy with postoperative epidural analgesia. These patients were matched with sixty-six control patients who underwent thoracotomy with postoperative epidural analgesia and were never diagnosed with PTPS. Results. Median (IQR) hospital stay was significantly different between control patients (5 days (4, 6)) compared with PTPS patients (6 days (5, 8)), P<0.02. The total opioid equivalent utilized in oral morphine equivalents in milligrams for the first three days postoperatively was significantly different between control patients and PTPS patients. The median (IQR) total opioid equivalent utilized was 237 (73, 508) for controls and 366 (116, 874) for PTPS patients (P<0.005). Conclusion. Patients with a prolonged hospital stay after thoracotomy were at an increased risk of developing PTPS, and this is a novel finding. Patients who utilize higher oral morphine equivalents for the first 3 days were also at increased risk for PTPS.

Epidural analgesia for reduction of postoperative systemic opioid use following selective dorsal rhizotomy in children

2021 ◽  
pp. 1-6
Author(s):  
Madeline B. Karsten ◽  
Steven J. Staffa ◽  
Craig D. McClain ◽  
Jennifer Amon ◽  
Scellig S. D. Stone
Keyword(s):  
Epidural Analgesia ◽  
Hospital Stay ◽  
Respiratory Support ◽  
Long Term Effects ◽  
Opioid Use ◽  
Selective Dorsal Rhizotomy ◽  
Dorsal Rhizotomy ◽  
Pain Scores ◽  
Opioid Administration ◽  
Postoperative Epidural Analgesia

OBJECTIVE Selective dorsal rhizotomy (SDR) requires significant postoperative pain management, traditionally relying heavily on systemic opioids. Concern for short- and long-term effects of these agents has generated interest in reducing systemic opioid administration without sacrificing analgesia. Epidural analgesia has been applied in pediatric patients undergoing SDR; however, whether this reduces systemic opioid use has not been established. In this retrospective cohort study, the authors compared postoperative opioid use and clinical measures between patients treated with SDR who received postoperative epidural analgesia and those who received systemic analgesia only. METHODS All patients who underwent SDR at Boston Children’s Hospital between June 2013 and November 2019 were reviewed. Treatment used the same surgical technique. Postoperative systemic opioid dosage (in morphine milligram equivalents per kilogram [MME/kg]), pain scores, need for respiratory support, vomiting, bowel movements, and length of hospital and ICU stay were compared between patients who received postoperative epidural analgesia and those who did not, by using the Wilcoxon rank-sum test or Fisher’s exact test. RESULTS A total of 35 patients were identified, including 18 females (51.4%), with a median age at surgery of 6.1 years. Thirteen patients received postoperative epidural and systemic analgesia and 22 patients received systemic analgesia only. Groups were otherwise similar, with treatment selection based solely on surgeon routine. Patients who received epidural analgesia required less systemic morphine milligram equivalents/kg on postoperative days (PODs) 0–4 (p ≤ 0.042). Patients who did not receive epidural analgesia were more likely to require respiratory support on POD 1 (45% vs 8%; p = 0.027). Reported pain scores did not differ between groups, although patients receiving epidural analgesia trended toward less severe pain on PODs 1 and 2. Groups did not differ with respect to postoperative vomiting or time to first bowel movement, although epidural analgesia use was associated with a longer hospital stay (median 7 vs 5 days; p < 0.001). CONCLUSIONS Patients who received postoperative epidural analgesia required less systemic opioid use and had at least equivalent reported pain scores on PODs 1–4, and they required less respiratory support on POD 1, although they remained in the hospital longer when compared to patients who received systemic analgesia only. A larger prospective study is needed to confirm whether epidural analgesia lowers systemic opioid use in children, contributes to a safer postoperative hospital stay, and results in better pain control following SDR.

Patient with Postthoracotomy Pain

2017 ◽  
Author(s):  
Jianguo Cheng ◽  
Olivia T Cheng
Keyword(s):  
Spinal Cord ◽  
Epidural Analgesia ◽  
Spinal Cord Stimulation ◽  
Pain Syndrome ◽  
Intercostal Nerve ◽  
Thoracic Epidural Analgesia ◽  
Intercostal Nerve Block ◽  
Thoracic Epidural ◽  
Postthoracotomy Pain ◽  
Intravenous Analgesia

Pain due to thoracotomy is among the most severe pain experienced after surgery. It has both neuropathic and myofascial components. About 50% of patients suffer from chronic postthoracotomy pain 1 year after surgery. Thoracic paravertebral block or thoracic epidural analgesia is recommended as the first-choice therapy for thoracotomy analgesia.  Preoperatively initiated thoracic epidural analgesia is associated with better pain control and decreased incidence (and intensity) of chronic postthoracotomy pain compared with postoperative (epidural or intravenous) analgesia. Compared with inhalation anesthesia, total intravenous anesthesia significantly reduced the incidence of chronic postthoracotomy pain syndrome, which is notoriously challenging to treat. Gabapentinoids and antidepressants may be beneficial for the neuropathic component of chronic postthoracotomy pain syndrome. A pregabalin and methylcobalamin combination has been shown to be safe and effective in the treatment of chronic postthoracotomy pain, with minimal side effects. Interventional therapies such as intercostal nerve block or ablation, spinal cord stimulation, and targeted subcutaneous neuromodulation may be indicated in more refractory and debilitating cases. This review contains 1 table, and 57 references. Key words: chronic postthoracotomy pain, cryoneurolysis, intercostal nerve block, open thoracotomy surgery, paravertebral block, postthoracotomy pain, postthoracotomy pain syndrome, spinal cord stimulation, thoracic epidural analgesia, thoracotomy, total intravenous analgesia, video-assisted thoracoscopic surgery

scholarly journals Risk Factors For Prolonged Opioid Use After Spine Surgery

2021 ◽  
pp. 219256822110038
Author(s):  
Christopher Kowalski ◽  
Ryan Ridenour ◽  
Sarah McNutt ◽  
Djibril Ba ◽  
Guodong Liu ◽  
...  
Keyword(s):  
Mental Health ◽  
Chronic Pain ◽  
Spine Surgery ◽  
Pain Syndrome ◽  
Lumbar Spine Surgery ◽  
Opioid Use ◽  
Chronic Regional Pain Syndrome ◽  
Increased Risk ◽  
Operative Complications ◽  
Post Operative Complications

Study Design: Retrospective review. Objective: Our purpose was to evaluate factors associated with increased risk of prolonged post-operative opioid pain medication usage following spine surgery, as well as identify the risk of various post-operative complications that may be associated with pre-operative opioid usage. Methods: The MarketScan commercial claims and encounters database includes approximately 39 million patients per year. Patients undergoing cervical and lumbar spine surgery between the years 2005-2014 were identified using CPT codes. Pre-operative comorbidities including DSM-V mental health disorders, chronic pain, chronic regional pain syndrome (CRPS), obesity, tobacco use, medications, and diabetes were queried and documented. Patients who utilized opioids from 1-3 months prior to surgery were identified. This timeframe was chosen to exclude patients who had been prescribed pre- and post-operative narcotic medications up to 1 month prior to surgery. We utilized odds ratios (OR), 95% Confidence Intervals (CI), and regression analysis to determine factors that are associated with prolonged post-operative opioid use at 3 time intervals. Results: 553,509 patients who underwent spine surgery during the 10-year period were identified. 34.9% of patients utilized opioids 1-3 months pre-operatively. 25% patients were still utilizing opioids at 6 weeks, 17.3% at 3 months, 12.7% at 6 months, and 9.0% at 1 year after surgery. Pre-operative opioid exposure was associated with increased likelihood of post-operative use at 6-12 weeks (OR 5.45, 95% CI 5.37-5.53), 3-6 months (OR 6.48, 95% CI 6.37-6.59), 6-12 months (OR 6.97, 95% CI 6.84-7.11), and >12 months (OR 7.12, 95% CI 6.96-7.29). Mental health diagnosis, tobacco usage, diagnosis of chronic pain or CRPS, and non-narcotic neuromodulatory medications yielded increased likelihood of prolonged post-op opioid usage. Conclusions: Pre-operative narcotic use and several patient comorbidities diagnoses are associated with prolonged post-operative opioid usage following spine surgery. Chronic opioid use, diagnosis of chronic pain, or use of non-narcotic neuromodulatory medications have the highest risk of prolonged post-operative opioid consumption. Patients using opiates pre-operatively did have an increased 30 and 90-day readmission risk, in addition to a number of serious post-operative complications. This data provides spine surgeons a number of variables to consider when determining post-operative analgesia strategies, and provides health systems, providers, and payers with information on complications associated with pre-operative opioid utilization.

scholarly journals Risk factors for delayed perineal wound healing and its impact on prolonged hospital stay after abdominoperineal resection

2019 ◽  
Vol 17 (1) ◽  
Author(s):  
Chu-Cheng Chang ◽  
Yuan-Tzu Lan ◽  
Jeng-Kai Jiang ◽  
Shih-Ching Chang ◽  
Shung-Haur Yang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Wound Healing ◽  
Hospital Stay ◽  
Independent Risk Factor ◽  
Perineal Wound ◽  
Prolonged Hospital Stay ◽  
Delayed Wound Healing ◽  
Perineal Wound Healing ◽  
Increased Risk ◽  
Prolonged Hospital

Abstract Background Perineal wound complications are a long-lasting issue for abdominoperineal resection (APR) patients. Complication rates as high as 60% have been reported, with the most common complication being delayed perineal wound healing. The aim of this study was to identify risk factors for delayed perineal wound healing and its impact on prolonged hospital stay. Methods We included low rectal tumor patients who underwent APR at a referral medical center from April 2002 to December 2017; a total of 229 patients were included. The basic characteristics and surgical outcomes of the patients were analyzed to identify risk factors for delayed perineal wound healing (> 30 days after APR) and prolonged hospital stay (post-APR hospital stay > 14 days). Results All patients received primary closure for their perineal wound. The majority of patients were diagnosed with adenocarcinoma (N = 213, 93.1%). In the univariate analysis, patients with hypoalbuminemia (albumin < 3.5 g/dL) had an increased risk of delayed wound healing (39.5% vs. 60.5%, P = 0.001), which was an independent risk factor in the multivariable analysis (OR 2.962, 95% CI 1.437–6.102, P = 0.003). Patients with delayed wound healing also had a significantly increased risk of prolonged hospital stay (OR 6.404, 95% CI 3.508–11.694, P < 0.001). Conclusions Hypoalbuminemia was an independent risk factor for delayed wound healing, which consequently led to a prolonged hospital stay. Further clinical trials are needed to reduce the incidence of delayed perineal wound healing by correcting albumin levels or nutritional status before APR.

FULMINANT CEREBRAL AIR EMBOLISM FOLLOWING ENDOVAC-THERAPY IN ESOPHAGEAL ANASTOMOTIC LEAKAGE – A RARE COMPLICATION

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
J Herzberg ◽  
R Jenner ◽  
T Strate ◽  
H Honarpisheh
Keyword(s):  
Hospital Stay ◽  
Anastomotic Leakage ◽  
Rare Complication ◽  
Air Embolism ◽  
Major Complication ◽  
Vacuum Therapy ◽  
Cerebral Air Embolism ◽  
Increased Risk ◽  
Risk Patients ◽  
Prolonged Hospital

Abstract Aim Anastomotic leakages after esophageal surgery is a major complication with an increased risk of mortality and an extended ICU and hospital stay. Surgical revisions or endoscopic interventions are standard procedures in treatment of such complications. The use of endoscopic endoluminal vacuum therapy (EVT) as introduced in the last years is considered a safe treatment. Background & Methods We analyzed 78 patients who underwent a surgical resection of the esophagus from January 2015 until December 2018. We compared patients with endovac-therapy to patients without such endoscopic intervention. Length of stay in ICU and in hospital, patient’s demographics and perioperative parameters were analyzed. Results In our center, we performed 78 esophageal resections from January 2015 to December 2018. In 14.1% (11 patients) an anastomotic leakage appeared, in 10 patients (12.8% of all cases) we performed an endovac-therapy. In the endovac- group, the mean postoperative hospital stay was 39 days (± 18 days), which is a significant longer postoperative in-hospital time in compare to the other patients (mean 17 days, ±8 days, p=0,004). Patients demographics and perioperative parameters were comparable in both groups. The postoperative 90-days mortality in the endovac-group was 20% (2 patients), in compare to a 90-days mortality rate of 4.4% in the group without an EVT. In one case we found the rare complication of an air embolism following an extended 35 days endovac-therapy. Endovac-therapy is a useful tool in the treatment of anastomotic leakage, although it is associated with a significantly prolonged hospital stay. Air embolism during endovac-therapy such as reported in this analysis, is a rare complication associated with endoscopic treatments. This is the first reported case of such an air embolism during endovac-therapy. Using carbon dioxide for endoscopic interventions might reduce the risk for air embolism, especially in high-risk-patients.

scholarly journals Managing Burns During COVID-19 Outbreak

2020 ◽  
Vol 41 (5) ◽  
pp. 1033-1036 ◽  
Author(s):  
Shivangi Saha ◽  
Aditya Kumar ◽  
Suvashis Dash ◽  
Maneesh Singhal
Keyword(s):  
Hospital Stay ◽  
Healthcare Professionals ◽  
Viral Transmission ◽  
Operative Procedures ◽  
Burn Patients ◽  
Prolonged Hospital Stay ◽  
Burn Care ◽  
Increased Risk ◽  
Prolonged Hospital ◽  
Safe Care

Abstract The coronavirus disease pandemic has affected our practice as healthcare professionals. As burn surgeons, we are obliged to provide the best possible care to our patients. However, due to the risk of viral transmission, the goal should be to provide safe care to our patients as well as ensure the safety of the whole team providing burn care. The burn patients are usually debilitated and require a prolonged hospital stay and multiple operative procedures which put them and everyone involved in their care at increased risk of coronavirus infections and transmission. This warrants special caution to the burn team while managing such patients. In this review, we aim to highlight the key considerations for burn care teams while dealing with burn patients during the COVID-19 pandemic.

A Retrospective Study of Venous Thromboembolism in Acute Leukemia Patients during Prolonged Hospital Stay. the Princess Margaret Cancer Centre Experience

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 2615-2615
Author(s):  
Hassan Sibai ◽  
Umberto Falcone ◽  
Arjun Datt Law ◽  
Ali Hosni ◽  
Carmen Tan ◽  
...  
Keyword(s):  
Acute Leukemia ◽  
Hospital Stay ◽  
Board Of Directors ◽  
Research Funding ◽  
Prolonged Hospital Stay ◽  
Advisory Committees ◽  
Vte Prophylaxis ◽  
Cancer Centre ◽  
Increased Risk ◽  
Prolonged Hospital

Abstract Background The role of thromboprophylaxis in solid organ malignancies is well established. Hematologic malignancies can also be associated with a considerable risk of thromboembolic complications. The incidence of these events is variable and is influenced by multiple factors. Limited data are available regarding the incidence of venous thromboembolism (VTE) in hospitalized acute leukemia (AL) patients. The management of symptomatic VTE in patients with AL can be challenging due to the increased risk of thrombocytopenia-related bleeding. Methods The Discharge summary Database (DAD) was used to extract post-admitted PE and DVT volumes in AL patients admitted to Princess Margaret Cancer Centre from 2007-2016. ICD-10-CA diagnosis codes for acute leukemia, and both PE and DVT events, were used. Only patients diagnosed with VTE at least 48 hours post-admission were included to restrict the cohort to patients that developed VTE during their admission. Results We analyzed a total of 10,041 patients that were admitted to Princess Margaret Cancer Centre during the 2007-2016 period. (Table 1) Of these, 7759 had a solid tumor diagnosis (271 VTE events, 3.4%) and 2282 patients had AL (1675 AML, 464 ALL, 144 APL). The AL patients (AML, ALL, APL) admitted to our Centre for chemotherapy or for the management of complications were further evaluated to determine VTE incidence and to evaluate its management in this setting. As of September 2012, patients with solid tumors treated at our Centre received standard thromboprophylaxis as part of an institutional in-patient (VTE) prophylaxis policy (IPP) that reduced the incidence of VTE from 4.8% (219/4520) to 1.6% (3239/52) before and after the policy was initiated, respectively. AL patients are not given prophylactic anticoagulation. 37 AL patients (22 AML, 10 ALL, and 5 APL; overall incidence 1.6%) developed symptomatic VTE (DVT only 23, PE only 8, DVT + PE 6). VTE was reported as central venous catheter related in 12/37 patients (32.4%). PE was detected in all cases by CT-PE. Median age of VTE patients was 53 years (range 32-77), with a median hospital stay of 35 days (range 2-144). Chemotherapy was given to 26 of the 37 patients that developed VTE, with 20 receiving initial induction chemotherapy. 17/37 (46%) patients had PLT<50.000/mm3 at VTE diagnosis. Full dose low molecular weight heparin with platelet transfusion support was used to treat 35/37 patients with acute VTE during the first month of treatment. 2/37 did not receive anticoagulation due to ongoing active bleeding. None of the treated patients experienced major bleeding. Conclusions In our experience, the incidence of VTE in AL patients during prolonged hospital stay is relatively low, raising questions about the need for routine VTE prophylaxis in this group. The relatively increased risk of VTE in AL patients receiving chemotherapy (particularly, induction chemotherapy), should prompt particular scrutiny in symptomatic patients. Disclosures Schuh: Amgen: Membership on an entity's Board of Directors or advisory committees. Yee:Novartis Canada: Membership on an entity's Board of Directors or advisory committees, Research Funding. Gupta:Incyte Corporation: Consultancy, Research Funding; Novartis: Consultancy, Honoraria, Research Funding. Schimmer:Novartis: Honoraria.

scholarly journals Influenza as an important factor causing increased risk of patients' deaths, excessive morbidity and prolonged hospital stays.

2021 ◽  
Author(s):  
Jarosław Drobnik ◽  
Piotr Pobrotyn ◽  
Izabela Witczak ◽  
Adam Antczak ◽  
Robert Susło
Keyword(s):  
Internal Medicine ◽  
Hospital Stay ◽  
Influenza Infection ◽  
Statistical Significance ◽  
University Hospital ◽  
Renal Diseases ◽  
Control Group ◽  
Risk Of Death ◽  
Increased Risk ◽  
Prolonged Hospital

IntroductionInfluenza infection is associated with potential serious complications, increased hospitalization rates and a higher risk of death.Material and methodsA retrospective comparative analysis of selected indicators of hospitalization at the University Hospital in Wrocław was conducted on patients with confirmed influenza infection and a control group during the 2018–2019 influenza season.The threshold for statistical significance of differences between the groups was set at p < 0.05.ResultsThe types of flu viruses confirmed in the hospital patients were remarkably similar to those occurring in the general population in Poland. The largest numbers of influenza cases were observed at the departments related to internal medicine where patients with cardiac, lung and renal diseases were hospitalized. The risk of death among the patients with confirmed influenza infection was significantly higher than among the other patients. The highest risk of death was observed among the patients with confirmed flu infection at the departments related to internal medicine. Considering patients from the entire hospital, the mean length of hospital stay for those with confirmed influenza was 2.13-fold greater than for those in the control group. Comparisons of the median, minimum and maximum lengths of hospitalization between the patients with confirmed flu infection and the control group reveal even more distinct differences.ConclusionsSignificant differences in the selected indicators of hospitalization were observed between the patients with confirmed influenza infection and the control group; they are associated with serious social costs, such as prolonged hospital stay and a higher risk of death during hospitalization in Poland.

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.

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