State-level variation in opioid prescribing after knee arthroscopy among the opioid-naïve in the USA: 2015–2019

ObjectiveIt has been established that most patients prescribed opioids after minor surgery have tablets left over, better understanding the variation in opioid prescribing and variation in dosage of the prescription could guide efforts to reduce prescribing. This study describes the state-level variation in opioid prescribing after a knee arthroscopy among opioid-naïve patients.DesignRetrospective cohort study.SettingCommercial insurance claims data.Participants98 623 individual across the USA with commercial insurance who were opioid-naïve and had a knee arthroscopy between 2015 and 2019.ExposurePatients who filled an opioid prescription within 3 days of a knee arthroscopy.Outcome measuresOpioid prescriptions were measured as a pharmacy claim for filling an opioid within 3 days of a knee arthroscopy. We measured the patient and state-level opioid prescribing rate, tablet count, morphine milligram equivalent dose per prescription and risk-adjusted predicted opioid quantity.ResultsOverall, 72% of patients filled an opioid prescription with a median tablet count of 40 and median morphine milligram equivalent of 250. Patients with an invasive procedure (27.9% vs 22.4%; p<0.001), higher education level (p<0.001) and fewer comorbidities (0.9 vs 1.2, p<0.001) had higher rates of opioid prescribing. The prescribing rate in the highest state, Nebraska (85%), was double the prescribing rate in the lowest state, South Dakota (40%). Comparing the casemix adjusted expected prescribing rate to the observed prescribing rate displayed that 18 states had observed prescribing rates that were higher than their expected prescribing rates.ConclusionWide variation in the likelihood of receiving a prescription, depending on state of residence, was observed. The dosages prescribed were high and have been associated with transition to long-term use. These findings suggest that there is substantial opportunity for the development of guidelines to reduce variability in opioid prescribing for this common ambulatory procedure.

Total Thyroidectomy as an Ambulatory Procedure in Community Practice

Objective Increasingly, total thyroidectomy is offered as an ambulatory procedure. Most of the relevant outcomes research derives from academic centers, but most thyroid surgeries are performed in the community. The goal of this study is to evaluate the safety of total thyroidectomy performed as an ambulatory procedure in a community otolaryngology practice. Study Design Retrospective review and national database analysis. Setting A single community otolaryngology practice. Methods Adult patients undergoing total thyroidectomy by a single otolaryngologist between 2013 and 2019 were divided into 2 cohorts: planned ambulatory and planned admission. Charts were reviewed for demographics and surgical outcomes in the 2 groups. The Healthcare Cost and Utilization Project databases for New York and Florida between 2015 and 2016 were also analyzed to compare outcomes of thyroidectomy as an ambulatory surgery between different practice settings. Results A total of 99 total thyroidectomies were performed during the study time period; 66 of 99 (67%) were planned as ambulatory procedures and 33 of 99 (33%) were planned admissions. Five of the 66 (8%) planned outpatient surgeries required admission. Complications of vocal fold dysfunction, symptomatic hypocalcemia, and seroma formation were more commonly seen in the inpatient cohort. Only 2 ambulatory patients required admission after discharge. Nationally, odds of complication were higher for ambulatory total thyroidectomy at nonteaching practice sites, which is not duplicated in our study. Conclusions Ambulatory total thyroidectomy can be undertaken safely in the community in carefully selected cases.

MON-LB81 Ultrasound-Guided Radiofrequency Ablation RFA of Benign Symptomatic Thyroid Nodules - Initial Colombian Experience

Introduction: Radiofrequency ablation (RF) is a minimally invasive technique probed as effective and safe treatment alternative for the manage, We describe the results of efficacy and safety up to 12 months following the first thyroid nodules with ablative radiofrequency in Colombia.Objective: Evaluate the efficacy and safety of RF thyroid radiofrequency ablation for benign thyroid nodules in a protocol in our center in Bogotá Colombia, case series. Methodology: Prospective, observational and descriptive Trial Patients and procedure: From May/2017 to Nov/2019 we Treated 38 patients with 59 mainly solid nodules were treated with a Radiofrequency Ablation system with cooling 2 standard techniques (Trans-isthmic approach and moving Shut technique). Starmed system with cool type antenna of 16 G. and 10 mm active tip (3 cases) and Cosman RF cooled with 15 cm long active tips 5 to 15 mm 18 G electro Teflon. (35 cases). Here the first 59 nodules who completed a clinical and ultrasound follow-up to 12 months. Outcomes: initial volume was 15.4 +/-28 cc (0.03 a 203 cc) After radiofrequency ablation, the volume decreased significantly, in VRR%**. 40%, 55%, 62% y 68% at 1,3,6 & 12 months. final volume was 4.46 cc P= 0.000*. Compressive Symptoms drop from 5.84 to 1.19, 0.17, 1.76 at 1,3 & 6 moths p &lt;0.001, Cosmetic Symptoms from 2.02/4 to 0.73, 0.58, 0.41 at 1,3 & 6 moths p &lt;0.01. and Quality of Life symptoms from 0 to 10 drop from 5.6 to 2.4, 1.27 & 1.53 at 1,3 & 6 moths p&lt;0.001. Not even one serious adverse event happened. Non-serious adverse events that did happened include minimal skin ecchymosis and transitory pain during less than 3 days, average 4/10 VAS (Visual Analog Scale). None developed hypothyroidism or required hospitalization. one patient presents transitory Horner syndrome and other nodule rupture. Two patients present a transitory dysphonia. Conclusions Radiofrequency ablation performed in our institution is effective and safe for the treatment of thyroid nodules. With patient satisfaction, improve the compressive, cosmetic symptoms and quality of life and without severe complications. It is necessary to continue to enrich this experience, because reducing volume and solving compressive and cosmetic problems, is ambulatory procedure.

Pulmonary Comorbidities in Endoscopic Retrograde Cholangio-Pancreatography Procedure and Ambulatory Anesthesia

Ambulatory surgery anesthesia is one of the fastest-growing subspecialties in anesthesia. Outpatient procedures cost less in the ambulatory setting than in hospitals and provide increased efficacy and convenience to both the proceduralist and the patient. The most common ambulatory procedure performed includes gastrointestinal procedures, performed under either general anesthesia or, more often, monitored anesthesia care. Although usually less complicated than most inpatient surgeries, anesthetic management in ambulatory surgery settings can be challenging and requires equal anesthesia expertise to be performed efficiently without compromising safety. This chapter uses the case study of a 63-year-old woman noticed to have jaundice and intermittent right upper quadrant abdominal pain since around 6 weeks ago who is scheduled to have an endoscopic retrograde cholangiopancreatography at the gastrointestinal suite of a tertiary medical center.