scholarly journals Prescribing Habits of Providers and Risk Factors for Nonadherence to Opioid Prescribing Guidelines

2020 ◽  
pp. 000313482095633
Author(s):  
Tommy Ivanics ◽  
Hassan Nasser ◽  
Pridvi Kandagatla ◽  
Shravan Leonard-Murali ◽  
Adam Jones ◽  
...  
Keyword(s):  
Risk Factors ◽  
Guideline Implementation ◽  
Multivariable Analysis ◽  
Acute Care Surgery ◽  
Factors Associated ◽  
Opioid Prescribing ◽  
Academic Center ◽  
American Society ◽  
Care Surgery ◽  
American Society Of Anesthesiologists

Background The Michigan Opioid Prescribing Engagement Network introduced guidelines in October 2017 to combat opioid overprescription following various surgical procedures. We sought to evaluate changes in opioid prescribing at our academic center and identify factors associated with nonadherence to recently implemented opioid prescribing guidelines. Methods This retrospective review analyzed opioid prescribing data for appendectomy, cholecystectomy, and hernia repair from January 2015 through September 2017 (pre-guidelines group) and November 2017 through December 2018 (post-guidelines group). October 2017 data were excluded to allow for guideline implementation. Opioid prescribing data were recorded as total morphine equivalents (TMEs). Results Of 1493 cases (903 pre-vs. 590 post-guidelines), the mean TME prescribed significantly decreased post-guidelines (231.9 ± 108.6 vs. 112.7 ± 73.9 mg; P < .01). More providers prescribed within recommended limits post-guidelines (2.8% vs. 44.8%; P < .01). On multivariable analysis, independent risk factors for guideline nonadherence were the American Society of Anesthesiologists class > 2 (adjusted odds ratio [AOR]:1.65, 95% confidence interval[CI] 1.09-2.49; P = .02), general surgery vs. acute care surgery service (AOR 1.89, 95% CI 1.15-3.10; P = .01), oxycodone vs. hydrocodone (AOR:1.90, 95% CI:1.06-3.41; P = .03), and nonphysician provider vs. resident prescriber (AOR:2.10, 95% CI:1.14-3.11; P < .01). Conclusions Opioid prescribing significantly reduced after the adoption of opioid prescribing guidelines at our institution. Numerous factors associated with provider guideline nonadherence may identify actionable targets to minimize opioid overprescribing further.

scholarly journals Risk Factors and Indications for 30-Day Readmission After Primary Surgery for Epithelial Ovarian Cancer

2015 ◽  
Vol 25 (2) ◽  
pp. 193-202 ◽  
Author(s):  
Mariam AlHilli ◽  
Carrie Langstraat ◽  
Christine Tran ◽  
Janice Martin ◽  
Amy Weaver ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ovarian Cancer ◽  
Postoperative Complications ◽  
Epithelial Ovarian Cancer ◽  
Odds Ratio ◽  
Residual Disease ◽  
Factors Associated ◽  
Primary Surgery ◽  
American Society ◽  
American Society Of Anesthesiologists

BackgroundTo identify patients at risk for postoperative morbidities, we evaluated indications and factors associated with 30-day readmission after epithelial ovarian cancer surgery.MethodsPatients undergoing primary surgery for epithelial ovarian cancer between January 2, 2003, and December 29, 2008, were evaluated. Univariable and multivariable logistic regression models were fit to identify factors associated with 30-day readmission. A parsimonious multivariable model was identified using backward and stepwise variable selection.ResultsIn total, 324 (60.2%) patients were stage III and 91 (16.9%) were stage IV. Of all 538 eligible patients, 104 (19.3%) were readmitted within 30 days. Cytoreduction to no residual disease was achieved in 300 (55.8%) patients, and 167 (31.0%) had measurable disease (≤1 cm residual disease). The most common indications for readmission were surgical site infection (SSI; 21.2%), pleural effusion/ascites management (14.4%), and thromboembolic events (12.5%). Multivariate analysis identified American Society of Anesthesiologists score of 3 or higher (odds ratio, 1.85; 95% confidence interval, 1.18–2.89;P= 0.007), ascites [1.76 (1.11–2.81);P= 0.02], and postoperative complications during initial admission [grade 3–5 vs none, 2.47 (1.19–5.16); grade 1 vs none, 2.19 (0.98–4.85); grade 2 vs none, 1.28 (0.74–2.21);P= 0.048] to be independently associated with 30-day readmission (c-index = 0.625). Chronic obstructive pulmonary disease was the sole predictor of readmission for SSI (odds ratio, 3.92; 95% confidence interval, 1.07–4.33;P= 0.04).ConclusionsClinically significant risk factors for 30-day readmission include American Society of Anesthesiologists score of 3 or higher, ascites and postoperative complications at initial admission. The SSI and pleural effusions/ascites are common indications for readmission. Systems can be developed to predict patients needing outpatient management, improve care, and reduce costs.

scholarly journals Analysis of urgent/emergent conversions from monitored anesthesia care to general anesthesia with airway instrumentation

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sang Kim ◽  
Brian A. Chang ◽  
Amreen Rahman ◽  
Hung-Mo Lin ◽  
Samuel DeMaria ◽  
...  
Keyword(s):  
Risk Factors ◽  
General Anesthesia ◽  
Mount Sinai Hospital ◽  
Anesthesia Care ◽  
Monitored Anesthesia Care ◽  
Surgical Specialty ◽  
Factors Associated ◽  
Physical Status Classification ◽  
American Society ◽  
American Society Of Anesthesiologists

Abstract Background Monitored Anesthesia Care (MAC) is an anesthetic service involving the titration of sedatives/analgesics to achieve varying levels of sedation while avoiding general anesthesia (GA) and airway instrumentation. The goal of our study was to determine the overall incidence of conversion from MAC to general anesthesia with airway instrumentation and elucidate reasons and risk factors for conversion. Methods In this retrospective observational study, all non-obstetric adult patients who received MAC from July 2002 to July 2015 at Mount Sinai Hospital were electronically screened for inclusion via a clinical database. Patient, procedure, anesthetic, and practitioner data were all collected and analyzed to generate descriptive analyses. Subsequent univariate and multivariate analyses were used to identify specific risk factors associated with conversion to GA. Results Overall, 0.50% (1097/219,061) of MAC cases were converted to GA. Approximately half of conversions were due to the patient’s “intolerance” of MAC (with or without failed regional anesthesia), while the other half were due to physiologic derangements. Body mass index, male sex, American Society of Anesthesiologists Physical Status Classification, anesthesia team composition, and surgical specialty were all associated with risk of conversion to GA. Conclusions This is one of the first and largest retrospective studies aimed at identifying reasons and risk factors associated with the conversion of MAC to GA. These findings may be used to help better anticipate or prevent these events.

scholarly journals Epidemiology and risk factors associated with surgical site infection following surgery on thoracic aorta

2018 ◽  
Vol 146 (14) ◽  
pp. 1841-1844
Author(s):  
K. Morikane
Keyword(s):  
Risk Factors ◽  
Surgical Site Infection ◽  
Thoracic Aorta ◽  
Artery Bypass ◽  
Univariate Analysis ◽  
National Database ◽  
Site Infection ◽  
Factors Associated ◽  
American Society ◽  
American Society Of Anesthesiologists

AbstractSurgical site infection (SSI) following cardiovascular surgery has been well documented, possibly owing to its highly invasive nature, but SSI following surgery on the thoracic aorta has not. This study aimed to describe the epidemiology and assess risk factors associated with the latter in Japan using a national database for SSI. Data on surgery on thoracic aorta performed between 2012 and 2014 were extracted from the Japan Nosocomial Infections Surveillance (JANIS) database. Risk factors were assessed initially by univariate analysis, and then entered into a logistic regression model for final evaluation. The cumulative incidence of SSI was 4.1% (146/3538) and staphylococci were the most frequent pathogens isolated. Factors such as the duration of operation, emergency surgery and male gender were significantly associated with SSI. These findings differ from previous studies on open heart and coronary artery bypass surgery, in which the American Society of Anesthesiologists (ASA) score was significantly associated with SSI, but gender was not. This study suggests that risk stratification in the JANIS system might be improved by incorporating additionally identified factors for risk adjustment, when comparing the incidence of SSI between hospitals.

Upper Gastrointestinal Endoscopy in an Academic General Surgical Program: Implications for Acute Care Surgeons

2020 ◽  
pp. 155335062095780
Author(s):  
James T. Ross ◽  
Norah E. Liang ◽  
Carter C. Lebares ◽  
Jonathan T. Carter ◽  
Hobart W. Harris ◽  
...  
Keyword(s):  
Success Rate ◽  
Acute Care ◽  
Endoscopic Therapy ◽  
Acute Care Surgery ◽  
Endoscopic Management ◽  
Upper Gastrointestinal Endoscopy ◽  
Endoscopic Techniques ◽  
Academic Center ◽  
American Society ◽  
Care Surgery

Background. Esophagogastroduodenoscopy (EGD) is an important tool in the evolving specialty of acute care surgery (ACS). Understanding the types of nonelective EGDs performed by ACS groups is important for the development of ACS programs and the training of future general surgeons. Methods. We conducted a retrospective review of all EGDs performed by ACS surgeons at a single urban academic center over a 5-year period (January 2013-December 2018). Results. A total of 495 EGDs were performed, of which 129 (26%) were urgent, nonelective procedures. Patients who underwent urgent EGD were younger than those who underwent elective procedures (median 55 vs 60 years, P = .03), had higher American Society of Anesthesiologists (ASA) classes (median ASA 3 vs 2, P = .0002), and longer hospital stays (median 5 days vs 0 days, P < .0001). The most common indications for urgent endoscopies were the management of leak, dysphagia, or stenosis in patients with a history of foregut surgery, followed by the management of esophageal perforation. The success rate of endoscopic therapy was high (median 88%, interquartile range (IQR) 78-89%). However, some patients required multiple interventions (median 1, IQR 1-3), and patients treated for leaks were less likely to be successfully treated with endoscopic therapy alone than patients treated for other indications (success rate 65% vs 88%, P = .003). Conclusions. Our experience suggests that EGD has an important role in current ACS practice and that endoscopic management is safe and effective in a range of urgent surgical scenarios. Future ACS surgeons should be facile with endoscopic techniques.

scholarly journals Ambulatory percutaneous nephrolithotomy is safe and effective in patients with extended selection criteria

2021 ◽  
Vol 16 (4) ◽  
Author(s):  
Gregory William Hosier ◽  
Kashif Visram ◽  
Thomas McGregor ◽  
Stephen Steele ◽  
Naji Touma ◽  
...  
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Selection Criteria ◽  
Multivariable Analysis ◽  
Solitary Kidney ◽  
Complication Rates ◽  
Prospective Data ◽  
Academic Center ◽  
Transplant Kidney ◽  
American Society ◽  
American Society Of Anesthesiologists

Introduction: Ambulatory percutaneous nephrolithotomy (PCNL) has been limited to highly selected patients. The objective of our study was to compare complication and stone-free rates after ambulatory PCNL in standard selection criteria vs. extended criteria patients. Methods: We conducted a retrospective review of prospective data on all patients who underwent ambulatory PCNL at one academic center from 2007–2018. Extended criteria patients were defined as one or more of: age >75 years, body mass index (BMI) >30 kg/m2, American Society of Anesthesiologists (ASA) >2, bilateral stones, solitary kidney, transplant kidney, complete staghorn calculi, stone burden >40 mm, multiple tracts, or prior nephrostomy tubes/stents. Primary outcomes were complication rates (Clavien-Dindo classification) and stone-free rates. Results: We identified 118 patients, of which 92 (78%) met extended criteria. Mean BMI was 31 kg/m2 and 45% were ASA 3 or higher. Mean sum maximum stone diameter was 24 mm. Multiple stones were present in 25%, bilateral stones in 7%, and complete staghorn stones in 4% of patients. There was no difference in complication (12% vs. 18%, p=0.56), emergency department visit (12% vs. 18%, p=0.56), or re-admission (4% vs. 5%, p=1) rates between standard and extended criteria patients respectively. Of the complications, 85% were Clavien-Dindo grade 1. Stone-free rates were not different between standard (84%) and extended (83%) criteria patients (p=1). No extended criteria variables were associated with complications in multivariable analysis. Conclusions: Complication and stone-free rates were not different between standard and extended selection criteria patients undergoing ambulatory PCNL. This data indicates that many of the preoperative patient and stone factors that have previously been used as exclusion criteria for ambulatory PCNL are not strictly necessary.

Variation of Opioid Prescribing Patterns among Patients undergoing Similar Surgery on the Same Acute Care Surgery Service of the Same Institution: Time for Standardization?

Surgery ◽  
2018 ◽  
Vol 164 (5) ◽  
pp. 926-930 ◽  
Author(s):  
Ahmed I. Eid ◽  
Christopher DePesa ◽  
Ask T. Nordestgaard ◽  
Napaporn Kongkaewpaisan ◽  
Jae Moo Lee ◽  
...  
Keyword(s):  
Acute Care ◽  
Prescribing Patterns ◽  
Acute Care Surgery ◽  
Opioid Prescribing ◽  
Care Surgery

scholarly journals Multivariable analysis to determine risk factors associated with early pregnancy loss in thoroughbred broodmares

2019 ◽  
Vol 124 ◽  
pp. 18-23 ◽  
Author(s):  
A.M. de Mestre ◽  
B.V. Rose ◽  
Y.M. Chang ◽  
D.C. Wathes ◽  
K.L.P. Verheyen
Keyword(s):  
Risk Factors ◽  
Early Pregnancy ◽  
Pregnancy Loss ◽  
Multivariable Analysis ◽  
Early Pregnancy Loss ◽  
Factors Associated

P0034IDENTIFICATION OF FACTORS ASSOCIATED WITH PROGRESSION, PROGNOSIS AND TOLVAPTAN INDICATION IN POLYCYSTIC KIDNEY DISEASE PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Myrto Kostopoulou ◽  
Michaela Louka ◽  
Stavros Fokas ◽  
Eirini Tigka ◽  
Angelos Drakopoulos ◽  
...  
Keyword(s):  
Risk Factors ◽  
Kidney Disease ◽  
Polycystic Kidney Disease ◽  
Multivariable Analysis ◽  
Laboratory Data ◽  
Kidney Volume ◽  
Polycystic Kidney ◽  
Factors Associated ◽  
Affected Parent ◽  
Male Sex

Abstract Background and Aims The identification of possible risk factors for the progression of Autosomal Dominant Polycystic Kidney Disease (ADPKD) is an emerging field especially after the introduction of the first disease-specific treatment. The present study aims to explore the associations between epidemiological, clinical and imagining data in a large cohort of ADPKD patients. Method This study was from a single outpatient clinic following patients with ADPKD. Patients were included in the study if they had a recent Magnetic Resonance Imaging (MRI) for measurement of Total Kidney Volume (TKV), a validated biomarker for disease progression. For all patients, the Mayo Clinic Imagining Category (MCIC) and the respective prediction for End Stage Renal Disease (ESRD) were calculated. Patients eligible for tolvaptan treatment (MCIC 1C, 1D, 1E, age &lt; 55 years old and estimated-glomerular filtration rate (e-GFR) ≥ 25 ml/min) were identified. Characteristics including individual medical history, clinical and laboratory data were examined for possible associations with renal and imagining parameters using linear regression models. Results A total of 158 patients were included. Based on measurements of height-adjusted TKV (ht-TKV) and age, 5% of the patients were classified as 1A, 20% as 1B, 34% as 1C, 25% as 1D and 16% as 1E, MCIC. In multivariable analysis, patient’s age (p = 0.01), male sex (p &lt; 0.001), parent’s age at which ESRD was reached (adjusted for patient age) (p &lt; 0.001) and proteinuria (p = 0.04) were associated with ht-TKV. Parent’s age at ESRD differed significantly between the MCICs of the offspring (mean±(SD)), 70.83 (12.90) in 1A, 63.79 (11.39) in 1B, 57.32 (10.42) in 1C, 51.42 (9.18) in 1D and 47.94 (5.73) years old in 1E, (p &lt; 0.001). Similarly, there were significant differences in the presence and the age of hypertension onset (p =0.004 and p = 0.003, respectively). In 104 patients (50 females, 54 males) who were eligible for tolvaptan treatment age at ADPKD diagnosis, age at hypertension onset and parent’s age reaching at ESRD were all significantly lower (p &lt; 0.001 for all) when compared to non-eligible patients. Finally, factors associated with the prediction score of ESRD (e-GFR 10/ml/min) were hypertension, uric acid and the age at ESRD of the affected parent (p = 0.001, 0.02 and 0.01, respectively). Conclusion The age at which an affected parent had reached ESRD, as heritability estimator, was significantly associated with a worst phenotype, prognosis and tolvaptan indication. Early diagnosis of the disease, hypertension and its early onset, proteinuria and male sex are also possible risk factors for the progression of ADPKD.

scholarly journals Postdischarge antibiotic use for prophylaxis following spinal fusion

2020 ◽  
Vol 41 (7) ◽  
pp. 789-798
Author(s):  
David K. Warren ◽  
Katelin B. Nickel ◽  
Jennifer H. Han ◽  
Pam Tolomeo ◽  
Christopher J. Hostler ◽  
...  
Keyword(s):  
Spinal Fusion ◽  
Linear Models ◽  
Prophylactic Antibiotic ◽  
Antibiotic Use ◽  
Prophylactic Antibiotics ◽  
Factors Associated ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
Surgical Admission ◽  
Significant Factors

AbstractObjective:Despite recommendations to discontinue prophylactic antibiotics after incision closure or <24 hours after surgery, prophylactic antibiotics are continued after discharge by some clinicians. The objective of this study was to determine the prevalence and factors associated with postdischarge prophylactic antibiotic use after spinal fusion.Design:Multicenter retrospective cohort study.Patients:This study included patients aged ≥18 years undergoing spinal fusion or refusion between July 2011 and June 2015 at 3 sites. Patients with an infection during the surgical admission were excluded.Methods:Prophylactic antibiotics were identified at discharge. Factors associated with postdischarge prophylactic antibiotic use were identified using hierarchical generalized linear models.Results:In total, 8,652 spinal fusion admissions were included. Antibiotics were prescribed at discharge in 289 admissions (3.3%). The most commonly prescribed antibiotics were trimethoprim/sulfamethoxazole (22.1%), cephalexin (18.8%), and ciprofloxacin (17.1%). Adjusted for study site, significant factors associated with prophylactic discharge antibiotics included American Society of Anesthesiologists (ASA) class ≥3 (odds ratio [OR], 1.31; 95% CI, 1.00–1.70), lymphoma (OR, 2.57; 95% CI, 1.11–5.98), solid tumor (OR, 3.63; 95% CI, 1.62–8.14), morbid obesity (OR, 1.64; 95% CI, 1.09–2.47), paralysis (OR, 2.38; 95% CI, 1.30–4.37), hematoma/seroma (OR, 2.93; 95% CI, 1.17–7.33), thoracic surgery (OR, 1.39; 95% CI, 1.01–1.93), longer length of stay, and intraoperative antibiotics.Conclusions:Postdischarge prophylactic antibiotics were uncommon after spinal fusion. Patient and perioperative factors were associated with continuation of prophylactic antibiotics after hospital discharge.

Outbreak ofShewanella algaeandShewanella putrefaciensInfections Caused by a Shared Measuring Cup in a General Surgery Unit in Korea

2008 ◽  
Vol 29 (8) ◽  
pp. 742-748 ◽  
Author(s):  
Hyang Soon Oh ◽  
Kyung Ah Kum ◽  
Eui-Chong Kim ◽  
Hoan-Jong Lee ◽  
Kang Won Choe ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Care Hospital ◽  
Surveillance Systems ◽  
Care Hospital ◽  
Human Pathogens ◽  
Logistic Analysis ◽  
Before And After ◽  
Contact Transmission ◽  
American Society ◽  
American Society Of Anesthesiologists

Objective.To control an outbreak ofShewanella algaeandS. putrefaciensinfections by identifying the risk factors for infection and transmission.Design.Matched case-control study.Setting.A university-affiliated tertiary acute care hospital in Seoul, Republic of Korea, with approximately 1,600 beds.Patients.From June 20, 2003, to January 16, 2004, a total of 31 case patients withShewanellacolonization or infection and 62 control patients were enrolled in the study.Interventions.Requirement to use single-use measuring cups and standard precautions (including hand washing before and after patient care and use of gloves).Results.S. algaeorS. putrefacienswas isolated from blood, for 9 (29.0%) of 31 patients who acquired one of the organisms; from bile, for 8 (25.8%), and from ascitic fluid, for 8 (25.8%). The attack rate of this outbreak was 5.8% (31 patients infected or colonized, of 534 potentially exposed on ward A) and the pathogenicity of the two species together was 77.4% (24 patients infected, of 31 who acquired the pathogens). The estimated incubation period forShewanellaacquisition was 3–49 days. Using logistic analysis, we identified the following risk factors: presence of external drainage catheters in the hepatobiliary system (odds ratio [OR], 20;P< .001), presence of hepatobiliary disease (OR, 6.4;P< .001), admission to the emergency department of the hospital (OR, 2.9;P= .039), wound classification of “contaminated” or “dirty or infected” (OR, 16.5;P= .012), an American Society of Anesthesiologists score of 3 or higher (OR, 8.0;P= .006), duration of stay in ward A (OR, 1.1;P< .001), and, for women, an age of 60–69 years (OR, 13.3;P= .028). AShewanellaisolate was recovered from the surface of a shared measuring cup, and 12 isolates ofS. algaeshowed the same pulsed-field gel electrophoresis pattern.Conclusions.ThisShewanellaoutbreak had a single-source origin and spread by contact transmission via a contaminated measuring cup.Shewanellaspecies are emerging as potentially serious human pathogens in hospitals and could be included in hospital infection surveillance systems.

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