scholarly journals Risk factors and outcomes associated with postoperative ileus following ileostomy formation: a retrospective study

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Anya L. Greenberg ◽  
Yvonne M. Kelly ◽  
Rachel E. McKay ◽  
Madhulika G. Varma ◽  
Ankit Sarin
Keyword(s):  
Risk Factors ◽  
Fluid Balance ◽  
Postoperative Ileus ◽  
Fluid Overload ◽  
Youden Index ◽  
Fluid Restriction ◽  
Opioid Use ◽  
Hospitalization Cost ◽  
Colorectal Surgeon ◽  
Procedure Duration

Abstract Background Postoperative ileus (POI) is associated with increased patient discomfort, length of stay (LOS), and healthcare cost. There is a paucity of literature examining POI in patients who have an ileostomy formed at the time of surgery. We aimed to identify risk factors for and outcomes associated with POI following ileostomy formation. Methods We included 261 consecutive non-emergent cases that included formation of an ileostomy by a board-certified colorectal surgeon at our institution from July 1, 2015, to June 30, 2020. Demographic, clinical, and intraoperative factors associated with increased odds of POI were evaluated. Post-procedure LOS, hospitalization cost, and re-admissions between patients with and without POI were compared. Results Out of 261 cases, 85 (32.6%) were associated with POI. Patients with POI had significantly higher body mass index (BMI) than those without POI (26.6 kg/m2 vs. 24.8kg/m2; p = 0.01). Intraoperatively, patients with POI had significantly longer procedure duration than those without POI (313 min vs. 279 min; p = 0.02). Patients with POI had a significantly higher net fluid balance at postoperative day (POD) 2 than those without POI (+ 2.65 L vs. + 1.80 L; p = 0.004), with POD2 fluid balance greater than + 807 mL (determined as the maximum Youden index for sensitivity over 80%) associated with a higher rate of POI (p = 0.006). This difference remained significant when adjusted for age, gender, BMI, pre-operative opioid use, procedure duration, and operative approach (p = 0.01). Patients with POI had significantly longer LOS (11.40 days vs. 5.12 days; p < 0.001) and direct cost of hospitalization ($38K vs. $22K; p < 0.001). Conclusions Minimizing fluid overload, particularly in the first 48 h after surgery, may be a strategy to reduce POI in patients undergoing ileostomy formation, and thus decrease postoperative LOS and hospitalization cost. Fluid restriction, diuresis, and changes in diet advancement or early stoma intubation should be considered measures that may improve outcomes and should be studied more intensively.

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.

Persistent Opioid Use After Ophthalmic Surgery in Opioid-Naive Patients and Associated Risk Factors

Ophthalmology ◽  
2021 ◽  
Author(s):  
Cindy Ung ◽  
Yoshihiro Yonekawa ◽  
Jennifer F. Waljee ◽  
Vidhya Gunaseelan ◽  
Yenling Lai ◽  
...  
Keyword(s):  
Risk Factors ◽  
Opioid Use ◽  
Ophthalmic Surgery ◽  
Associated Risk Factors

scholarly journals Risk Factors for Opioid Use after Patellofemoral Stabilization Surgery: Analyses of 1,316 Cases

2021 ◽  
Vol 37 (1) ◽  
pp. e75
Author(s):  
Jacqueline Baron ◽  
Zain Khazi ◽  
Kyle R. Duchman ◽  
Brian R. Wolf ◽  
Robert W. Westermann
Keyword(s):  
Risk Factors ◽  
Opioid Use

scholarly journals Prevalence, risk factors and impact on outcomes of 30-day unexpected rehospitalization in incident peritoneal dialysis patients

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jianbo Li ◽  
Jing Yu ◽  
Naya Huang ◽  
Hongjian Ye ◽  
Dan Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Regression Analysis ◽  
Peritoneal Dialysis ◽  
Fluid Overload ◽  
Multivariate Logistic Regression Analysis ◽  
Technical Failure ◽  
Cox Regression Analysis ◽  
Catheter Malfunction ◽  
All Cause Mortality ◽  
Cvd Mortality

Abstract Background Rehospitalization is a major problem for end stage renal disease (ESRD) populations. However, researches on 30-day unexpected rehospitalzation of incident peritoneal dialysis (PD) patients were limited. This study aimed to investigate the prevalence, risk factors and impact on outcomes of 30-day unexpected rehospitalization in incident PD patients. Methods This was a retrospective cohort study. Patients who accepted PD catheter implantation in our centre from Jan 1, 2006 to Dec 31, 2013 and regular follow-up were included. The demographic characteristics, laboratory parameters, and rehospitalization data were collected and analyzed. The primary outcome was all-cause mortality, and the secondary outcomes included cardiovascular disease (CVD) mortality and technical failure. Results Totally 1632 patients (46.9 ± 15.3 years old, 60.1% male, 25.6% with diabetes) were included. Among them, 149 (9.1%) had a 30-day unexpected rehospitalization after discharge. PD-related peritonitis (n = 48, 32.2%), catheter malfunction (n = 30, 20.1%) and severe fluid overload (n = 19, 12.8%) were the top three causes for the rehospitalization. Multivariate logistic regression analysis showed that length of index hospital stays [Odds ratio (OR) =1.02, 95% confidence interval (CI) 1.00–1.03, P = 0.036) and hyponatremia (OR = 1.85, 95% CI 1.06–3.24, P = 0.031) were independently associated with the rehospitalization. Multivariate Cox regression analysis indicated that 30-day rehospitalization was an independent risk factor for all-cause mortality [Hazard ratio (HR) =1.52, 95% CI 1.07–2.16, P = 0.019) and CVD mortality (HR = 1.73, 95% CI 1.03–2.90, P = 0.038). Conclusions The prevalence of 30-day unexpected rehospitalization for incident PD patients in our centre was 9.1%. The top three causes for the rehospitalization were PD-related peritonitis, catheter malfunction and severe fluid overload. Thirty-day unexpected rehospitalization increased the risk of all-cause mortality and CVD mortality for PD patients.

scholarly journals Risk factors for postoperative ileus after urologic laparoscopic surgery

2011 ◽  
Vol 80 (6) ◽  
pp. 384 ◽  
Author(s):  
Myung Joon Kim ◽  
Gyeong Eun Min ◽  
Koo Han Yoo ◽  
Sung-Goo Chang ◽  
Seung Hyun Jeon
Keyword(s):  
Risk Factors ◽  
Laparoscopic Surgery ◽  
Postoperative Ileus

New Persistent Opioid Use and Associated Risk Factors Following Treatment of Ankle Fractures

2019 ◽  
Vol 40 (9) ◽  
pp. 1043-1051 ◽  
Author(s):  
Timothy D. Gossett ◽  
Fred T. Finney ◽  
Hsou Mei Hu ◽  
Jennifer F. Waljee ◽  
Chad M. Brummett ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Treatment ◽  
Ankle Fracture ◽  
Opioid Use ◽  
Patient Factors ◽  
Distal Fibula ◽  
Opioid Prescription ◽  
Opioid Dose ◽  
Closed Treatment ◽  
Open Treatment

Background:The aim of this study was to define the rate of new persistent opioid use and risk factors for persistent opioid use after operative and nonoperative treatment of ankle fractures.Methods:Using a nationwide insurance claims database, Clinformatics DataMart Database, we identified opioid-naïve patients who underwent surgical treatment of unstable ankle fracture patterns between January 2009 and June 2016. Patients who underwent closed treatment of a distal fibula fracture served as a comparative group. We evaluated peritreatment and posttreatment opioid prescription fills. The primary outcome, new persistent opioid use, was defined as opioid prescription fulfillment between 91 and 180 days after the procedure. Logistic regression was used to evaluate the effect of patient factors, and the differences of the effect were tested using Wald statistics. The adjusted persistent use rates were calculated. A total of 13 088 patients underwent treatment of an ankle fracture and filled a peritreatment opioid prescription.Results:When compared with closed treatment of a distal fibula fracture, only 2 surgical treatment subtypes demonstrated significantly increased rates of persistent use compared with the closed treatment group: open treatment of bimalleolar ankle fracture (adjusted odds ratio [aOR], 1.32; 95% CI, 1.10-1.58; P = .002) and open treatment of trimalleolar ankle fracture with fixation of posterior lip (aOR, 1.47; 95% CI, 1.04-2.07; P = .027). Rates were significantly increased (aOR, 1.56; 95% CI, 1.34-1.82; P < .001) among patients who received a total peritreatment opioid dose that was in the top 25th percentile of total oral morphine equivalents. Factors independently associated with new persistent opioid use included mental health disorders, comorbid conditions, tobacco use, and female sex.Conclusion:All ankle fracture treatment groups demonstrated high rates of new persistent opioid use, and persistent use was not directly linked to injury severity. Instead, we identified patient factors that demonstrated increased risk of persistent opioid use. Limiting the peritreatment opioid dose was the largest modifiable risk factor related to new persistent opioid use in this privately insured cohort.Level of Evidence:Level III, retrospective cohort study.

Multivariate Analysis on Risk Factors for Postoperative Ileus After Lateral Lumbar Interbody Fusion

Spine ◽  
2014 ◽  
Vol 39 (8) ◽  
pp. 688-694 ◽  
Author(s):  
Motasem A. Al Maaieh ◽  
Jerry Y. Du ◽  
Alexander Aichmair ◽  
Russel C. Huang ◽  
Alexander P. Hughes ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Postoperative Ileus ◽  
Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Lateral Lumbar Interbody Fusion

scholarly journals Combating escalating harms associated with pharmaceutical opioid use in Australia: the POPPY II study protocol

BMJ Open ◽  
2018 ◽  
Vol 8 (12) ◽  
pp. e025840 ◽  
Author(s):  
Natasa Gisev ◽  
Sallie-Anne Pearson ◽  
Timothy Dobbins ◽  
David C Currow ◽  
Fiona Blyth ◽  
...  
Keyword(s):  
Risk Factors ◽  
Opioid Dependence ◽  
Service Use ◽  
Population Level ◽  
Ethics Committee ◽  
Adverse Outcomes ◽  
Opioid Use ◽  
Research Committee ◽  
Services Research ◽  
Wide Range

IntroductionOpioid prescribing has increased 15-fold in Australia in the past two decades, alongside increases in a range of opioid-related harms such as opioid dependence and overdose. However, despite concerns about increasing opioid use, extramedical use and harms, there is a lack of population-level evidence about the drivers of long-term prescribed opioid use, dependence, overdose and other harms.Methods and analysisWe will form a cohort of all adult residents in New South Wales (NSW), Australia, who initiated prescribed opioids from 2002 using Pharmaceutical Benefits Scheme dispensing records. This cohort will be linked to a wide range of other datasets containing information on sociodemographic and clinical characteristics, health service use and adverse outcomes (eg, opioid dependence and non-fatal and fatal overdose). Analyses will initially examine patterns and predictors of prescribed opioid use and then apply regression and survival analysis to quantify the risks and risk factors of adverse outcomes associated with prescribed opioid use.Ethics and disseminationThis study has received full ethical approval from the Australian Institute of Health and Welfare Ethics Committee, the NSW Population and Health Services Research Committee and the ACT Health Human Research Ethics Committee. This will be the largest postmarketing surveillance study of prescribed opioids undertaken in Australia, linking exposure and outcomes and examining risk factors for adverse outcomes of prescribed opioids. As such, this work has important translational promise, with direct relevance to regulatory authorities and agencies worldwide. Project findings will be disseminated at scientific conferences and in peer-reviewed journals. We will also conduct targeted dissemination with policy makers, professional bodies and peak bodies in the pain, medicine and addiction fields through stakeholder workshops and advisory groups. Results will be reported in accordance with the REporting of studies Conducted using Observational Routinely collected Data (RECORD) Statement.

scholarly journals POJOK BACA (BALANCE CAIRAN) UNTUK SURVIVOR HEMODIALISIS

2018 ◽  
Vol 2 (2) ◽  
pp. 138
Author(s):  
Eska Dwi Prajayanti
Keyword(s):  
Kidney Failure ◽  
Fluid Intake ◽  
Fluid Overload ◽  
Hemodialysis Patients ◽  
Fluid Restriction ◽  
End Stage Renal Failure ◽  
Severity Of The Disease ◽  
The Right ◽  
End Stage

Background: Management of end-stage renal failure patients one of the treatments is hemodialysis. Complications that arise with respect to fluid overload in patients with kidney failure can be prevented through effective and efficient fluid intake restrictions. Efforts to create restrictions on fluid intake in patients with kidney failure can be done through monitoring fluid intake per day. Fluid restriction program in patients in order to prevent complications and maintain quality of life, it is necessary to analyze practices related to intervention in controlling the amount of fluid intake through recording the amount of fluid taken and urine released every day. Pojok Balance Cairan (BACA) is one way to help hemodialysis patients learn how to calculate fluid needs in their body and help determine dietary settings for hemodialysis patients where in the reading corner will be explained related to how to calculate fluid balance and how the right diet in patients hemodialysis according to the severity of the disease. Method of implementation: lectures and demonstrations. Conclusion: POJOK BACA can prolong the life of patients undergoing hemodialysis because it can reduce the risk of complications that arise such as shortness of breath.Keywords: Hemodialysis, Liquid, Pojok Baca

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