scholarly journals Perioperative Factors Associated With Chronic Opioid Use After Spine Surgery

2021 ◽  
pp. 219256822110357
Author(s):  
Eric Y. Montgomery ◽  
Mark N. Pernik ◽  
Zachary D. Johnson ◽  
Luke J. Dosselman ◽  
Zachary K. Christian ◽  
...  
Keyword(s):  
Risk Factors ◽  
Spine Surgery ◽  
Medical Center ◽  
Lumbar Fusion ◽  
Academic Medical Center ◽  
Opioid Use ◽  
Retrospective Case ◽  
Opioid Prescription ◽  
Factors Associated ◽  
Chronic Opioid Use

Study Design: Retrospective case control. Objectives: The purpose of the current study is to determine risk factors associated with chronic opioid use after spine surgery. Methods: In our single institution retrospective study, 1,299 patients undergoing elective spine surgery at a tertiary academic medical center between January 2010 and August 2017 were enrolled into a prospectively collected registry. Patients were dichotomized based on renewal of, or active opioid prescription at 3-mo and 12-mo postoperatively. The primary outcome measures were risk factors for opioid renewal 3-months and 12-months postoperatively. These primarily included demographic characteristics, operative variables, and in-hospital opioid consumption via morphine milligram equivalence (MME). At the 3-month and 12-month periods, we analyzed the aforementioned covariates with multivariate followed by bivariate regression analyses. Results: Multivariate and bivariate analyses revealed that script renewal at 3 months was associated with black race ( P = 0.001), preoperative narcotic ( P < 0.001) or anxiety/depression medication use ( P = 0.002), and intraoperative long lumbar ( P < 0.001) or thoracic spine surgery ( P < 0.001). Lower patient income was also a risk factor for script renewal ( P = 0.01). Script renewal at 12 months was associated with younger age ( P = 0.006), preoperative narcotics use ( P = 0.001), and ≥4 levels of lumbar fusion ( P < 0.001). Renewals at 3-mo and 12-mo had no association with MME given during the hospital stay or with the usage of PCA ( P > 0.05). Conclusion: The current study describes multiple patient-level factors associated with chronic opioid use. Notably, no metric of perioperative opioid utilization was directly associated with chronic opioid use after multivariate analysis.

scholarly journals Predictive Risk Factors Associated With Increased Opioid Use Among Patients Undergoing Elective Spine Surgery

10.14444/7025 ◽  
2020 ◽  
Vol 14 (2) ◽  
pp. 189-194
Author(s):  
ZACHARY SANFORD ◽  
ANDREW BRODA ◽  
HALEY TAYLOR ◽  
JUSTIN TURCOTTE ◽  
CHAD M. PATTON
Keyword(s):  
Risk Factors ◽  
Spine Surgery ◽  
Opioid Use ◽  
Factors Associated ◽  
Predictive Risk

Changing Epidemiology of Community-Onset Methicillin-Resistant Staphylococcus aureus Bacteremia

2003 ◽  
Vol 24 (6) ◽  
pp. 431-435 ◽  
Author(s):  
Leonard B. Johnson ◽  
Arti Bhan ◽  
Joan Pawlak ◽  
Odette Manzor ◽  
Louis D. Saravolatz
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Electric Fields ◽  
Medical Center ◽  
Academic Medical Center ◽  
Care Facility ◽  
Retrospective Case ◽  
Term Care ◽  
Methicillin Resistant ◽  
Community Onset

AbstractObjectives:To review cases of community-onset Staphylococcus aureus bacteremia and to evaluate whether the risk factors and epidemiology of methicillin-resistant S. aureus (MRSA) bacteremia have changed from early reports.Design:Retrospective case-comparison study of community-onset MRSA (n - 26) and methicillin-susceptible S. aureus (MSSA) (n = 26) bacteremias at our institution.Setting:A 600-bed urban academic medical center.Patients:Twenty-six patients with community-onset MRSA bacteremia were compared with 26 patients with community-onset MSSA bacteremia. Molecular analysis was performed on S. aureus isolates from the 26 MRSA cases as well as from 13 cases of community-onset S. aureus bacteremia from 1980 and 9 cases of nosocomial S. aureus bacteremia from 2001.Results:The two groups were similar except that patients with MRSA bacteremia were more likely to have presented from a long-term-care facility (26.9% vs 4%; P = .05) and to have had multiple admissions within the preceding year (46% vs 15%; P = .03). Clamped homogeneous electric fields analysis of MRSA isolates from 1982 revealed predominantly that one clone was the epidemic strain, whereas there were 14 unique strains among current community-onset isolates. Among current nosocomial isolates, 3 patterns were identified, all of which were present in the community-onset cases.Conclusions:Previously described risk factors for MRSA acquisition may not be helpful in predicting disease due to the polyclonal spread of MRSA in the community. Unlike early outbreaks of MRSA in patients presenting from the community, current acquisition appears to be polyclonal and is usually related to contact with the healthcare system.

Risk factors associated with persistent chronic opioid use following THA

2020 ◽  
Vol 30 (4) ◽  
pp. 681-688 ◽  
Author(s):  
Afshin A. Anoushiravani ◽  
Kelvin Y. Kim ◽  
Mackenzie Roof ◽  
Kevin Chen ◽  
Casey M. O’Connor ◽  
...  
Keyword(s):  
Risk Factors ◽  
Opioid Use ◽  
Factors Associated ◽  
Chronic Opioid Use

scholarly journals Short- and Long-term Opioid Use in Patients with Oral and Oropharynx Cancer

2018 ◽  
Vol 160 (3) ◽  
pp. 409-419 ◽  
Author(s):  
Jessica D. McDermott ◽  
Megan Eguchi ◽  
William A. Stokes ◽  
Arya Amini ◽  
Mohammad Hararah ◽  
...  
Keyword(s):  
Risk Factors ◽  
Radiation Treatment ◽  
Cell Cancer ◽  
Population Based ◽  
Opioid Use ◽  
Opioid Prescription ◽  
National Health Care ◽  
Opiate Use ◽  
Chronic Opioid Use ◽  
Medicare Database

Objective Opioid use and abuse is a national health care crisis, yet opioids remain the cornerstone of pain management in cancer. We sought to determine the risk of acute and chronic opioid use with head and neck squamous cell cancer (HNSCC) treatment. Study Design Retrospective population-based study. Setting Surveillance, Epidemiology and End Results (SEER)–Medicare database from 2008 to 2011. Subjects and Methods In total, 976 nondistant metastatic oral cavity and oropharynx patients undergoing cancer-directed treatment enrolled in Medicare were included. Opiate use was the primary end point. Univariate and multivariable logistic analyses were completed to determine risk factors. Results Of the patients, 811 (83.1%) received an opioid prescription during the treatment period, and 150 patients (15.4%) had continued opioid prescriptions at 3 months and 68 (7.0%) at 6 months. Opioid use during treatment was associated with prescriptions prior to treatment (odds ratio [OR], 3.28; 95% confidence interval [CI], 2.11-5.12) and was least likely to be associated with radiation treatment alone (OR, 0.35; 95% CI, 0.18-0.68). Risk factors for continued opioid use at both 3 and 6 months included tobacco use (OR, 2.23; 95% CI, 1.05-4.71 and OR, 3.84; 95% CI, 1.44-10.24) and opioids prescribed prior to treatment (OR, 3.84; 95% CI, 2.45-5.91 and OR, 3.56; 95% CI, 1.95-6.50). Oxycodone prescribed as the first opioid was the least likely to lead to ongoing use at 3 and 6 months (OR, 0.33; 95% CI, 0.17-0.62 and OR, 0.26; 95% CI, 0.10-0.67). Conclusion Patients with oral/oropharyngeal cancer are at a very high risk for receiving opioids as part of symptom management during treatment, and a significant portion continues use at 3 and 6 months after treatment completion.

scholarly journals Opioid Prescription Patterns and Risk Factors Associated With Opioid Use in the Netherlands

2019 ◽  
Vol 2 (8) ◽  
pp. e1910223 ◽  
Author(s):  
Ajda Bedene ◽  
Willem M. Lijfering ◽  
Marieke Niesters ◽  
Monique van Velzen ◽  
Frits R. Rosendaal ◽  
...  
Keyword(s):  
Risk Factors ◽  
The Netherlands ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Prescription Patterns ◽  
Factors Associated

Risk Factors and Outcomes Associated With Non–Enterococcus faecalis, Non–Enterococcus faeciumEnterococcal Bacteremia

2006 ◽  
Vol 27 (1) ◽  
pp. 28-33 ◽  
Author(s):  
Marie A. de Perio ◽  
Paul R. Yarnold ◽  
John Warren ◽  
Gary A. Noskin
Keyword(s):  
Risk Factors ◽  
Hospital Stay ◽  
Enterococcus Faecalis ◽  
Hematologic Malignancy ◽  
Medical Center ◽  
Academic Medical Center ◽  
Clinical Feature ◽  
Retrospective Case ◽  
Duration Of Hospital Stay ◽  
The Mean

Objectives.To compare risk factors, clinical features, and outcomes in patients withEnterococcus avium,Enterococcus casseliflavus,Enterococcus durans,Enterococcus gallinarum, andEnterococcus mundtiibacteremia (cases) with those in patients withEnterococcus faecalisbacteremia (controls).Design.A retrospective case-control study.Setting.A 725-bed, university-affiliated, academic medical center.Patients.The clinical microbiology database at Northwestern Memorial Hospital from January 1994 to May 2003 was searched to identify cases; each case was matched to one control on the basis of date of admission.Results.Thirty-three cases were identified and matched with 33 controls. The mean duration of hospital stay was longer (29.7 vs 17.2 days;P= .03) and the mean time to acquisition of bacteremia was greater (16.5 vs 6.3 days;P= .003) for cases than controls. Cases were more likely to have underlying hematologic malignancies (P< .001), to have been treated with corticosteroids (P= .02), and to be neutropenic (P= .003). Controls were more likely to have an indwelling bladder catheter (P= .01), and cases were more likely to have the gastrointestinal tract as a source of infection (P= .007) and to have concurrent cholangitis (P= .002). There were no differences in severity of illness or in mortality rates.Conclusions.Compared with patients withE. faecalisbacteremia, patients with non-E. faecalis, non-Enterococcus faeciumenterococcal bacteremia were more likely to have a hematologic malignancy, prior treatment with corticosteroids, neutropenia, and cholangitis; longer duration of hospital stay was also identified as a clinical feature. However, non-E. faecalis, non-E. faeciumspecies are not associated with any differences in mortality.

Risk Factors Associated With 90-Day Readmissions After Degenerative Lumbar Fusion: An Examination of the Michigan Spine Surgery Improvement Collaborative (MSSIC) Registry

Neurosurgery ◽  
2018 ◽  
Vol 85 (3) ◽  
pp. 402-408 ◽  
Author(s):  
Paul Park ◽  
David R Nerenz ◽  
Ilyas S Aleem ◽  
Lonni R Schultz ◽  
Michael Bazydlo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Spine Surgery ◽  
Lumbar Fusion ◽  
Private Insurance ◽  
Fusion Surgery ◽  
Factors Associated ◽  
Lumbar Fusion Surgery ◽  
Independent Risk Factors ◽  
Artery Disease ◽  
Radicular Symptoms

Abstract BACKGROUND Most studies have evaluated 30-d readmissions after lumbar fusion surgery. Evaluation of the 90-d period, however, allows a more comprehensive assessment of factors associated with readmission. OBJECTIVE To assess the reasons and risk factors for 90-d readmissions after lumbar fusion surgery. METHODS The Michigan Spine Surgery Improvement Collaborative (MSSIC) registry is a prospective, multicenter, and spine-specific database of patients surgically treated for degenerative disease. MSSIC data were retrospectively analyzed for causes of readmission, and independent risk factors impacting readmission were found by multivariate logistic regression. RESULTS Of 10 204 patients who underwent lumbar fusion, 915 (9.0%) were readmitted within 90 d, most commonly for pain (17%), surgical site infection (16%), and radicular symptoms (10%). Risk factors associated with increased likelihood of readmission were other race (odds ratio [OR] 1.81, confidence interval [CI] 1.22-2.69), coronary artery disease (OR 1.57, CI 1.25-1.96), ≥4 fused levels (OR 1.41, CI 1.06-1.88), diabetes (OR 1.34, CI 1.10-1.63), and surgery length (OR 1.09, CI 1.03-1.16). Factors associated with decreased risk were discharge to home (OR 0.63, CI 0.51-0.78), private insurance (OR 0.79, CI 0.65-0.97), ambulation same day of surgery (OR 0.81, CI 0.67-0.97), and spondylolisthesis diagnosis (OR 0.82, CI 0.68-0.97). Of those readmitted, 385 (42.1%) patients underwent another surgery. CONCLUSION Ninety-day readmission occurred in 9.0% of patients, mainly for pain, wound infection, and radicular symptoms. Increased focus on postoperative pain may decrease readmissions. Among factors impacting the likelihood of 90-d readmission, early postoperative ambulation may be most easily modifiable. Optimization of preexisting medical conditions could also potentially decrease readmission risk.

scholarly journals Evaluation of early postoperative intravenous opioid rescue as a novel quality measure in patients who receive thoracic epidural analgesia: a retrospective cohort analysis and prospective performance improvement intervention

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nadav Levy ◽  
Peter Santer ◽  
Liana Zucco ◽  
Sarah Nabel ◽  
Galina Korsunsky ◽  
...  
Keyword(s):  
Epidural Analgesia ◽  
Medical Center ◽  
Cohort Analysis ◽  
Academic Medical Center ◽  
Thoracic Epidural Analgesia ◽  
Sensory Level ◽  
Opioid Use ◽  
Rescue Analgesia ◽  
Thoracic Epidural ◽  
Chronic Opioid Use

Abstract Background In this study, we explored the utility of intravenous opioid rescue analgesia in the post anesthesia care unit (PACU-OpResc) as a single marker of thoracic epidural analgesia (TEA) failure and evaluated the resource implications and quality improvement applications of this measure. Methods We performed a retrospective analysis of all TEA placements over a three-year period at a single academic medical center in Boston, Massachusetts. The study exposure was PACU-OpResc. Primary outcome was PACU length of stay (LOS). Secondary outcomes included reasons for delayed PACU discharge and intraoperative hypotension. The analyses were adjusted for confounding variables including patient comorbidities, surgical complexity, intraoperative intravenous opioids, chronic opioid use and local anesthetic bolus through TEA catheter. Post analysis chart review was conducted to determine the positive predictive value (PPV) of PACU-OpResc for inadequate TEA. As a first Plan-Do-Study-Act cycle, we then introduced a checkbox for documentation of a sensory level check after TEA placement. Post implementation data was collected for 7 months. Results PACU-OpResc was required by 211 (22.1%) patients who received preoperative TEA, was associated with longer PACU LOS (incidence rate ratio 1.20, 95% CI:1.07–1.34, p = 0.001) and delayed discharge due to inadequate pain control (odds ratio 5.15, 95% CI 3.51–7.57, p <  0.001). PACU-OpResc had a PPV of 76.3 and 60.4% for re-evaluation and manipulation of the TEA catheter in PACU, respectively. Following implementation of a checkbox, average monthly compliance with documented sensory level check after TEA placement was noted to be 39.7%. During this time, a reduction of 8.2% in the rate of PACU-OpResc was observed. Conclusions This study demonstrates that PACU-OpResc can be used as a quality assurance measure or surrogate for TEA efficacy, to track performance and monitor innovation efforts aimed at improving analgesia, such as our intervention to facilitate sensory level checks and reduced PACU-OpResc. Trial registration not applicable.

Risk Factors for Prolonged Opioid Use After Open Treatment of Distal Radius Fractures

Hand ◽  
2021 ◽  
pp. 155894472098810
Author(s):  
Mia M. Qin ◽  
Charles D. Qin ◽  
Chirag M. Shah
Keyword(s):  
Risk Factors ◽  
Distal Radius ◽  
Significant Risk ◽  
Distal Radius Fractures ◽  
Opioid Use ◽  
Radius Fractures ◽  
Opioid Prescription ◽  
Logistic Regression Models ◽  
Factors Associated ◽  
Open Treatment

Background The objective of this study was to evaluate factors associated with postoperative opioid use after open treatment of distal radius fractures. Methods The Humana insurance claims database was queried for open treatment of distal radius fractures by Current Procedural Terminology codes. The search was further refined to identify patients who filled an opioid prescription within 6 weeks after their surgery. The study’s outcomes were: (1) limited postoperative opioid use, defined as filling a prescription once in the 6-week to 6-month period after surgery; and (2) persistent postoperative opioid use, defined as filling a prescription more than once in the 6-week to 6-month period after surgery. Logistic regression models were performed to identify factors associated with limited and persistent postoperative opioid use. Subgroup analyses were performed among opioid-naïve patients and those with open fractures. Results This study identified 9141 of 19 220 total patients with limited and persistent opioid use. Significant risk factors included nonhome discharge, inpatient surgical setting, long-term pain, tobacco abuse, and age less than 65 years. Of note, both preoperative opioid use within 1 month before surgery (odds ratio [OR], 2.6; 95% confidence interval [CI], 2.2-2.9) and preoperative opioid use between 1 and 6 months before surgery (OR, 4.0; 95% CI, 3.7-4.4) were significantly associated with persistent postoperative opioid use. Conclusions This study has identified numerous risk factors associated with postoperative opioid use after open treatment of distal radius fractures. Understanding these risk factors is the first step toward reducing postoperative opioid use.

Should Excess Topical Decongestant Use Raise a Red Flag? Rhinitis Medicamentosa and Opioid Use Disorder

2019 ◽  
Vol 129 (2) ◽  
pp. 164-169
Author(s):  
Aneesh Patel ◽  
Jessica R. Levi ◽  
Christopher D. Brook
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Opioid Use Disorder ◽  
Opioid Abuse ◽  
Opioid Use ◽  
Retrospective Case ◽  
Chronic Rhinitis ◽  
Icd 10 ◽  
Red Flag ◽  
Rhinitis Medicamentosa

Objective: The objective of this study was to determine whether patients with rhinitis medicamentosa (RM) have an increased odds of having an opioid use disorder (OUD) and which characteristics may predict this association. Methods: The authors conducted a retrospective case control study of patients 18 years and older who presented to the otolaryngology clinic at an academic medical center from January 2013 through December 2017. Cases, defined as patients who presented with excessive decongestant nasal spray usage based on history, were matched to control patients who presented with chronic rhinitis and did not report regular nasal decongestant usage. The charts were reviewed for patients that carried a problem of opioid abuse, identified using ICD-9 codes 304.XX or ICD-10 codes F11.XX. The primary outcome of this study was the odds of having an OUD. Secondary outcomes were assessed by summary statistics. Results: One hundred and thirty-one cases of RM were matched to 1871 controls of chronic rhinitis. Seven cases (5.3%) and 24 (1.3%) controls had a diagnosis of OUD, consistent with an odds ratio of 3.98 for opioid abuse in patients with RM (95% CI: 1.47-9.71). Oxymetazoline was used by 85.5% (n = 112) of patients with RM. Thirty-six patients (27.1%) with RM underwent nasal surgery following a diagnosis of RM, of which twenty patients (55.6%) were prescribed opioids following the procedure. Conclusions: RM is associated with increased odds of having an OUD.

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