scholarly journals Predictors of Prolonged Opioid Use After Lumbar Fusion and the Effects of Opioid Use on Patient-Reported Outcome Measures

2021 ◽  
pp. 219256822110419
Author(s):  
Jose A Canseco ◽  
Michael Chang ◽  
Brian A Karamian ◽  
Jennifer Z Mao ◽  
Ariana A Reyes ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Smoking Status ◽  
Lumbar Fusion ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Opioid Use ◽  
Current Smoking Status ◽  
Current Smoking ◽  
Patient Reported ◽  
One Year

Study Design Retrospective case series. Objective To determine risk factors associated with prolonged opioid use after lumbar fusion and to elucidate the effect of opioid use on patient-reported outcome measures (PROMs) after surgery. Methods Patients who underwent 1–3 level lumbar decompression and fusion with at least one-year follow-up were identified. Opioid data were collected through the Pennsylvania Prescription Drug Monitoring Program. Preoperative “chronic use” was defined as consumption of >90 days in the one-year before surgery. Postoperative “prolonged use” was defined as a filled prescription 90-days after surgery. PROMs included the following: Short Form-12 Health Survey PCS-12 and MCS-12, ODI, and VAS-Back and Leg scores. Logistic regression was performed to determine independent predictors for prolonged opioid use. Results The final analysis included 260 patients. BMI >35 (OR: .44 [.20, .90], P = .03) and current smoking status (OR: 2.73 [1.14, 6.96], P = .03) significantly predicted postoperative opioid usage. Chronic opioid use before surgery was associated with greater improvements in MCS-12 (β= 5.26 [1.01, 9.56], P = .02). Patients with prolonged opioid use self-reported worse VAS-Back (3.4 vs 2.1, P = .003) and VAS-Leg (2.6 vs 1.2, P = .03) scores after surgery. Prolonged opioid use was associated with decreased improvement in VAS-Leg over time (β = .14 [.15, 1.85], P = .02). Conclusions Current smoking status and lower BMI were significantly predictive of prolonged opioid use. Excess opioid use before and after surgery significantly affected PROMs after lumbar fusion.

Preoperative Opioid Use in Patients Undergoing Common Hand Surgeries

Hand ◽  
2021 ◽  
pp. 155894472097412
Author(s):  
Ali Aneizi ◽  
Dominique Gelmann ◽  
Dominic J. Ventimiglia ◽  
Patrick M. J. Sajak ◽  
Vidushan Nadarajah ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Hand Surgery ◽  
Patient Characteristics ◽  
Patient Reported Outcome Measures ◽  
Pain Scale ◽  
Patient Reported Outcome ◽  
Measurement Information ◽  
Opioid Use ◽  
Patient Reported ◽  
Opioid Users

Background: The objectives of this study were to determine the baseline patient characteristics associated with preoperative opioid use and to establish whether preoperative opioid use is associated with baseline patient-reported outcome measures in patients undergoing common hand surgeries. Methods: Patients undergoing common hand surgeries from 2015 to 2018 were retrospectively reviewed from a prospective orthopedic registry at a single academic institution. Medical records were reviewed to determine whether patients were opioid users versus nonusers. On enrollment in the registry, patients completed 6 Patient-Reported Outcomes Measurement Information System (PROMIS) domains (Physical Function, Pain Interference, Fatigue, Social Satisfaction, Anxiety, and Depression), the Brief Michigan Hand Questionnaire (BMHQ), a surgical expectations questionnaire, and Numeric Pain Scale (NPS). Statistical analysis included multivariable regression to determine whether preoperative opioid use was associated with patient characteristics and preoperative scores on patient-reported outcome measures. Results: After controlling for covariates, an analysis of 353 patients (opioid users, n = 122; nonusers, n = 231) showed that preoperative opioid use was associated with higher American Society of Anesthesiologists class (odds ratio [OR], 2.88), current smoking (OR, 1.91), and lower body mass index (OR, 0.95). Preoperative opioid use was also associated with significantly worse baseline PROMIS scores across 6 domains, lower BMHQ scores, and NPS hand scores. Conclusions: Preoperative opioid use is common in hand surgery patients with a rate of 35%. Preoperative opioid use is associated with multiple baseline patient characteristics and is predictive of worse baseline scores on patient-reported outcome measures. Future studies should determine whether such associations persist in the postoperative setting between opioid users and nonusers.

scholarly journals Diabetes is not associated with greater pain and worse patient-reported outcome measures one year after laminoplasty for cervical spondylotic myelopathy

2021 ◽  
Author(s):  
Kosei Nagata ◽  
Junya Miyahara ◽  
Hideki Nakamoto ◽  
Naohiro Kawamura ◽  
Yujiro Takeshita ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Cervical Spondylotic Myelopathy ◽  
Rating Scale ◽  
Short Form ◽  
Neck Disability Index ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Diabetic Group ◽  
Patient Reported ◽  
One Year

Abstract Although patients with diabetes reportedly have more peripheral neuropathy, the impacts of diabetes on postoperative recovery in pain and patient-reported outcome measures (PROMs) after laminoplasty for cervical spondylotic myelopathy (CSM) is not well characterized. The authors aimed to elucidate the effects of diabetes on neck/arm/hand/leg/foot pain and PROMs after laminoplasty CSM. The authors retrospectively reviewed 339 patients (82 with diabetes and 257 without) who underwent laminoplasty between C3 and C7 in 11 hospitals during April 2017−October 2019. Preoperative Numerical Rating Scale (NRS) scores in all five areas, the Short Form-12 Mental Component Summary, Euro quality of life 5-dimension, Neck Disability Index, and the Core Outcome Measures Index-Neck) were comparable between the groups. The between-group differences were also not significant in NRS scores and PROMs one after surgery. The change score of NRS hand pain was larger in the diabetic group than the nondiabetic group. The diabetic group showed worse preoperative score but greater improvement in the Short Form-12 Physical Component Summary than the nondiabetic group, following comparable score one year after surgery. These data indicated that the preoperative presence of diabetes, at least, did not adversely affect pain or PROMs one year after laminoplasty for CSM.

Quality Assurance in Cataract and Lens Surgery with Special Consideration of Subjective Patient Reported Outcome Measures and Clinical Reported Outcome Measures

2021 ◽  
Author(s):  
Ekkehard Fabian ◽  
Max Birkl ◽  
Franz Benstetter ◽  
Philipp Eberwein ◽  
Ulrich Seher ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Outcome Measure ◽  
Data Transfer ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
High Rate ◽  
Automatic Data ◽  
Medical Interventions ◽  
Patient Reported ◽  
One Year

Abstract Background Results of medical interventions must be documented and evaluated. In studies, this is done with clinical outcomes data (clinician/clinical reported outcome measure, CROM). In the past, less weight has been given to patient surveys with questionnaires (patient reported outcome measure, PROM). Patients/Materials and Methods This retrospective study included 104 eyes from 53 patients. Of these, 35 patients had cataract surgery and 15 patients had a refractive lens exchange. The implanted lenses included 62 trifocal IOLs (Asphina trifiocal 839, Zeiss), 34 trifocal toric IOLs (Asphina trifocal toric 939, Zeiss) and 8 bifocal IOLs (Asphina 808, Zeiss) with the same IOL platform. Patients completed a modified questionnaire before surgery and one year after surgery. We made changes to the CatQuest-9SF questionnaire so as to also document side effects. Results The effort required by the patients to answer the questionnaire was a burden. Transcribing the data into electronic files so as they could be saved and analyzed was a lot of work for the staff. Among the patients, 88.7% were spectacle-independent in everyday life, and 77.5% for reading. 44.4% had a halo problem. 92% reported the operation as a success. 100% had a prediction error of ≤ ± 0.75 dpt. Conclusion There is a high rate of patient satisfaction with the outcome of the intervention. New questionnaires are needed for new IOLs. The Catquest-9SF is from 2009. Accordingly, revisions and new validation is necessary. Beyond that, only automatic data transfer will reduce the amount of work involved in data input.

Interpretation of patient-reported outcome measures for varicose vein surgery

2011 ◽  
Vol 27 (4) ◽  
pp. 173-178 ◽  
Author(s):  
C Nesbitt ◽  
W R W Wilson ◽  
T A Lees ◽  
G Stansby
Keyword(s):  
Outcome Measures ◽  
Varicose Vein ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Varicose Vein Surgery ◽  
Patient Reported ◽  
Potential Impact ◽  
One Year ◽  
The One ◽  
Preoperative Score

Objectives Since 2009 the National Health Service (NHS) has been collecting patient-reported outcome measures (PROMs) following varicose vein interventions. The objective of this manuscript was to interrogate the one-year PROMs data with respect to varicose vein intervention and to discuss its potential impact on the provision of service. Methods We interrogated the one-year PROMs data with respect to potential impact on the provision of service. Results In total, 37,521 varicose vein operations were performed during the study period (1 April 2009–30 April 2010). A total of 15,808 preoperative questionnaires were completed and returned and 12,509 were linked to Hospital Episode Statistics episodes. A total of 8127 postoperative questionnaires were completed and linked to the preoperative questionnaires. For the EuroQuol (EQ) 5D questionnaire average preoperative score across the completed data-set was 0.773. The postoperative health gain was 0.094. Fifty-three percent of patients had improved postoperative scores, 33% reported no change, while 14% reported a reduction in their postoperative EQ-5D score. Pain/discomfort was the only domain where patients reported any negative symptoms; 72% (5390) reported pain/discomfort preoperatively and 37% (2804) postoperatively. In total, 62.6% (4685) reported no pain/discomfort following surgery A total of 7167 complete, linked and eligible data-sets were observed for the Aberdeen Varicose Vein Questionnaire (AVVQ). The average preoperative score was 18.75. The average postoperative score was 10.76. This represented a reduction in symptom scores of one-half following intervention. The lowest improvements were witnessed in patients with the lowest preoperative scores (least severe symptoms). Additional postoperative questions highlighted the improvements conferred from varicose vein surgery with 90.3% of patients reporting an improvement in their problems from varicose veins following surgery and 85% describing their operative results as excellent, very good or good. Conclusion These data have shown variable improvements following venous interventions. PROMs are likely to have significant implications for health care in the NHS on a number of levels including provision of funding and future planning of services.

Impact of Postoperative Opioid Use on 2-Year Patient-Reported Outcomes in Knee Surgery Patients

2021 ◽  
Author(s):  
Xuyang Song ◽  
Patrick M.J. Sajak ◽  
Ali Aneizi ◽  
Aymen Alqazzaz ◽  
Cameran I. Burt ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Patient Reported Outcomes ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Knee Surgery ◽  
Older Age ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Medical Comorbidities ◽  
Patient Reported

AbstractThe purposes of this study were to identify the patient characteristics associated with refilling a postoperative opioid prescription after knee surgery and to determine whether refilling opioids is associated with 2-year patient-reported outcomes. We hypothesized that postoperative refill of opioids would be associated with worse 2-year patient-reported outcomes. We studied 192 patients undergoing knee surgery at a single urban academic institution. Patients completed multiple patient-reported outcome measures preoperatively and 2 years postoperatively, including six Patient-Reported Outcomes Measurement Information System (PROMIS) domains, the International Knee Documentation Committee (IKDC) questionnaire, numeric pain scale scores for the operative knee and the rest of the body, Marx Activity Rating Scale, as well as measures of met expectations, improvement, and satisfaction. Total morphine equivalents (TMEs) were calculated from a regional prescription monitoring program. Patients who refilled a postoperative opioid prescription were compared with those who did not, and TMEs were calculated for those who refilled (Refill TMEs). One hundred twenty-nine patients (67%) refilled at least one postoperative opioid prescription. Black race, older age, higher average body mass index (BMI), smoking, greater medical comorbidities, preoperative opioid use, lower income, government insurance, and knee arthroplasty were associated with refilling opioids. Greater Refill TMEs was associated with black or white race, older age, higher average BMI, smoking, greater medical comorbidities, preoperative opioid use, government insurance, and unemployment. Refilling opioids and greater Refill TMEs were associated with worse postoperative scores on most patient-reported outcome measures 2 years after knee surgery. However, refilling opioids and greater Refill TMEs did not have a significant association with improvement after surgery. Multivariable analysis controlling for potential confounding variables confirmed that greater postoperative Refill TMEs independently predicted worse 2-year PROMIS Physical Function, 2-year PROMIS Pain Interference, and 2-year IKDC knee function scores. Postoperative refill of opioids was associated with worse 2-year patient-reported outcomes in a dose-dependent fashion. These findings reinforce the importance of counseling patients regarding opioid use and optimizing opioid-sparing pain management postoperatively.

Feasibility of collecting survey-based patient-reported outcome measures (PROMs) from patients living with advanced cancer: Emerging findings from the Living with Colorectal Cancer study.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 207-207
Author(s):  
Marc Kerba ◽  
Shireen Kassam ◽  
Crystal Beaumont ◽  
Patricia Biondo ◽  
Madalene Earp ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Outcome Measures ◽  
Advanced Cancer ◽  
Healthcare Providers ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Cancer Study ◽  
Study Materials ◽  
Patient Reported ◽  
One Year

207 Background: The “Living with Colorectal Cancer study” seeks to characterize the experiences of patients diagnosed with advanced colorectal cancer to inform care improvements. Here we describe our experiences recruiting patients and collecting patient reported outcome measures (PROMs). Methods: Eligible patients were identified by oncologists in Alberta, Canada’s two tertiary cancer centres and approached for consent to participate during routine appointments. Following baseline surveys, participants were given a choice of completing monthly surveys via email, phone, post, or in person. We purposively chose previously validated surveys already in use provincially, including EQ-5D-5L and Putting Patients First. We endeavoured to include non-English speaking participants by providing translated study materials and interpretation. Results: In one year of recruitment, 88 patients were enrolled. Edmonton, Alberta’s patient recruitment (N = 62) is double that of Calgary, Alberta (N = 26), despite similar population sizes. In Calgary and Edmonton, 81% and 56% of participants chose email-based PROMs surveys, respectively. The current missing survey rate is 12% (i.e. surveys not completed per month). Forty-eight participants (55%) completed ≥6 sets of monthly PROMs data; 26 (30%) transferred “off study” (61% of which died). Several participants expressed the desire to describe their experiences beyond what the surveys could accommodate. Despite language accommodation, all participants chose to complete surveys in English; however, 21% reported speaking another language daily. Conclusions: It is challenging but possible to engage and retain patients with advanced cancer in research focused on PROMs. Speaking with patients face-to-face in cancer clinics increased the burden on healthcare providers (i.e. clinic flow and time spent with patients), but appears to be a practical and appropriate way to recruit participants. Offering multiple methods of communication allowed patients to participate in a manner most practical for their lifestyle and did not impact PROMs collection. Clinical trial information: NCT03572101.

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