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Szczesniak L, Britton S, Rn TB, Sullivan R. Low-dose overlap initiation with split tablets of buprenorphine in intubated intensive care unit patients with opioid use disorder. Harm Reduct J 2024; 21:114. [PMID: 38849912 PMCID: PMC11157744 DOI: 10.1186/s12954-024-01028-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 05/29/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND As the opioid public health crisis evolves to include fentanyl and other potent synthetic opioids, more patients are admitted to the hospital with serious complications of drug use and frequently require higher levels of care, including intensive care unit (ICU) admission, for acute and chronic conditions related to opioid use disorder (OUD). This patient population poses a unique challenge when managing sedation and ensuring adequate ventilation while intubated given their high opioid requirements. Starting a patient on medications such as buprenorphine may be difficult for inpatient providers unfamiliar with its use, which may lead to undertreatment of patients with OUD, prolonged mechanical ventilation and length of stay. METHODS We developed a 7-day buprenorphine low dose overlap initiation (LDOI) schedule for patients with OUD admitted to the ICU (Table 1). Buprenorphine tablets were split by pharmacists and placed into pre-made blister packs as a kit to be loaded into the automated medication dispensing machine for nursing to administer daily. An internal quality review validated the appropriate dosing of split-dose tablets. To simplify order entry and increase prescriber comfort with this new protocol, we generated an order set within our electronic health record software with prebuilt buprenorphine titration orders. This protocol was implemented alongside patient and healthcare team education and counseling on the LDOI process, with follow-up offered to all patients upon discharge. RESULTS Here we report a series of 6 ICU patients started on buprenorphine using the LDOI schedule with split buprenorphine tablets. None of the 6 patients experienced precipitated withdrawal upon buprenorphine initiation using the LDOI schedule, and 5/6 patients were successfully extubated during the buprenorphine initiation. Four of six patients had a decrease in daily morphine milligram equivalents, with 3 patients transitioning to buprenorphine alone. CONCLUSION Initiating buprenorphine via LDOI was found to be successful in the development of a protocol for critically ill patients with OUD. We examined LDOI of buprenorphine in intubated ICU patients and found no events of acute precipitated withdrawal. This protocol can be used as a guide for other institutions seeking to start critically ill patients on medication treatment for OUD during ICU admission.
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Affiliation(s)
- Laura Szczesniak
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, 53208, USA
| | - Sarah Britton
- Department of Clinical Pharmacy, Syracuse VA Medical Center, Syracuse, NY, 13210, USA
- Department of Pharmacy, Upstate Medical University, Syracuse, NY, 13210, USA
| | - Theresa Baxter Rn
- Department of Addiction Medicine, Upstate Medical University, Syracuse, NY, 13210, USA
| | - Ross Sullivan
- Department of Emergency Medicine, Upstate Medical University, Syracuse, NY, 13210, USA.
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Khoraminejad B, Sakowitz S, Gao Z, Chervu N, Curry J, Ali K, Bakhtiyar SS, Benharash P. Association of substance-use disorder with outcomes of major elective abdominal operations: A contemporary national analysis. Surg Open Sci 2024; 19:44-49. [PMID: 38585038 PMCID: PMC10995883 DOI: 10.1016/j.sopen.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 03/15/2024] [Indexed: 04/09/2024] Open
Abstract
Background Affecting >20million people in the U.S., including 4 % of all hospitalized patients, substance use disorder (SUD) represents a growing public health crisis. Evaluating a national cohort, we aimed to characterize the association of concurrent SUD with perioperative outcomes and resource utilization following elective abdominal operations. Methods All adult hospitalizations entailing elective colectomy, gastrectomy, esophagectomy, hepatectomy, and pancreatectomy were tabulated from the 2016-2020 National Inpatient Sample. Patients with concurrent substance use disorder, comprising alcohol, opioid, marijuana, sedative, cocaine, inhalant, hallucinogen, or other psychoactive/stimulant use, were considered the SUD cohort (others: nSUD). Multivariable regression models were constructed to evaluate the independent association between SUD and key outcomes. Results Of ∼1,088,145 patients, 32,865 (3.0 %) comprised the SUD cohort. On average, SUD patients were younger, more commonly male, of lowest quartile income, and of Black race. SUD patients less frequently underwent colectomy, but more often pancreatectomy, relative to nSUD.Following risk adjustment and with nSUD as reference, SUD demonstrated similar likelihood of in-hospital mortality, but remained associated with increased odds of any perioperative complication (Adjusted Odds Ratio [AOR] 1.17, CI 1.09-1.25). Further, SUD was linked with incremental increases in adjusted length of stay (β + 0.90 days, CI +0.68-1.12) and costs (β + $3630, CI +2650-4610), as well as greater likelihood of non-home discharge (AOR 1.54, CI 1.40-1.70). Conclusions Concurrent substance use disorder was associated with increased complications, resource utilization, and non-home discharge following major elective abdominal operations. Novel interventions are warranted to address increased risk among this vulnerable population and address significant disparities in postoperative outcomes.
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Affiliation(s)
- Baran Khoraminejad
- CORELAB, Department of Surgery, University of California, Los Angeles, Los Angeles, CA, United States of America
- Boston University, Boston, MA, United States of America
| | - Sara Sakowitz
- CORELAB, Department of Surgery, University of California, Los Angeles, Los Angeles, CA, United States of America
| | - Zihan Gao
- CORELAB, Department of Surgery, University of California, Los Angeles, Los Angeles, CA, United States of America
| | - Nikhil Chervu
- CORELAB, Department of Surgery, University of California, Los Angeles, Los Angeles, CA, United States of America
- Department of Surgery, University of California, Los Angeles, Los Angeles, CA, United States of America
| | - Joanna Curry
- CORELAB, Department of Surgery, University of California, Los Angeles, Los Angeles, CA, United States of America
| | - Konmal Ali
- CORELAB, Department of Surgery, University of California, Los Angeles, Los Angeles, CA, United States of America
| | - Syed Shahyan Bakhtiyar
- CORELAB, Department of Surgery, University of California, Los Angeles, Los Angeles, CA, United States of America
- Department of Surgery, University of Colorado, Denver, Aurora, CO, United States of America
| | - Peyman Benharash
- CORELAB, Department of Surgery, University of California, Los Angeles, Los Angeles, CA, United States of America
- Department of Surgery, University of California, Los Angeles, Los Angeles, CA, United States of America
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Xiao Y, Chen Y, Huang R, Jiang F, Su C, Zhou J. Incidence, risk factors, and outcomes of chylothorax after cardiac procedure in the United States. Heliyon 2024; 10:e29054. [PMID: 38638975 PMCID: PMC11024541 DOI: 10.1016/j.heliyon.2024.e29054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 03/04/2024] [Accepted: 03/28/2024] [Indexed: 04/20/2024] Open
Abstract
Background To examine the epidemiology and risk factors of chylothorax after cardiac procedure in the United States using a contemporary nationally representative database. Methods We identified postoperative chylothorax events through National Inpatient Sample database (2016-2019) and compared baseline demographics, comorbidities, and in-hospital outcomes between hospitalizations with and without postoperative chylothorax. The Cochrane-Armitage test was used to analyze trends in incidence rates. Multivariable Poisson regression models were used to identify potential risk factors for postoperative chylothorax after cardiac procedure. Results A total of 819 (0.24%) admissions were associated with postoperative chylothorax. The crude and standardized incidence rates of chylothorax were 23.7 (95%CI, 22.1-25.4) and 61.5 per 10,000 cardiac procedure-related admissions, respectively, with no significant temporal change in incidence rate over the study period (Ptrend = 0.5249). Infants [adjusted rate ratio (aRR), 117.3, 95% confidence interval (CI), 94.5-145.5] and children (aRR, 60.2, 95%CI, 48.0-75.5) were more likely to develop chylothorax compared to adults. Heart and great vessel procedures (aRR, 4.36, 95%CI, 3.61-5.26), septal repair (aRR, 1.91, 95%CI, 1.58-2.29), heart transplant (aRR, 5.68, 95%CI, 4.55-7.10) and pericardial procedures (aRR, 4.04, 95%CI, 3.32-4.91) were associated with elevated risk for chylothorax. Admissions with chylothorax were associated with higher inpatient mortality (4.9% vs. 3.0%, p<0.0001), longer inpatient stay, higher costs and greater perioperative complication burden. Conclusions Following cardiac procedures, chylothorax is an uncommon but serious complication that affects the prognosis. The analysis reveals varying incidence rates across age groups and specific surgical procedures, with infants at elevated risk.
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Affiliation(s)
- Yue Xiao
- School of International Business, China Pharmaceutical University, Jiangsu, China
| | - Yanfei Chen
- School of International Business, China Pharmaceutical University, Jiangsu, China
| | - Ruijian Huang
- School of International Business, China Pharmaceutical University, Jiangsu, China
| | - Feng Jiang
- School of International Business, China Pharmaceutical University, Jiangsu, China
| | - Cunhua Su
- Cardiothoracic and Vascular Surgery, Nanjing First Hospital, Jiangsu, China
| | - Jifang Zhou
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, Jiangsu, China
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4
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Yue Y, Ji H, Wang S, Cheng H, Wang R, Qu H, Li J. Evaluation of Analgesic Drug Therapy for Postoperative Pain Management in Cardiovascular Surgery. CURRENT THERAPEUTIC RESEARCH 2024; 100:100744. [PMID: 38803585 PMCID: PMC11128826 DOI: 10.1016/j.curtheres.2024.100744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 03/14/2024] [Indexed: 05/29/2024]
Abstract
Background Cardiovascular surgery is usually associated with higher degree of postoperative pain that influences a patient's physical recovery. Multiple clinical measures have been taken to avoid overuse of opioid agents for postoperative pain management, which led to the development of clinical pathways for analgesic drug treatment using a multimodal approach. Objective To evaluate the effectiveness and safety of a multimodal postoperative analgesic drug pathway (ADP) for pain management following cardiovascular surgery. Methods This retrospective, controlled, nonrandomized study evaluated a postoperative ADP in patients undergoing cardiovascular surgery in a tertiary general hospital in Qingdao, China. Effectiveness and safety outcomes were compared before and after the implementation of the ADP. Outcome indicators included postoperative pain scores, consumption of opioids in analgesic pumps, and incidence of adverse events. Results Patients who underwent cardiovascular surgery from September to November 2021 before the implementation of the ADP (n = 193) and from September to November 2022 after the implementation of the ADP (n = 218) were enrolled. Pain scores were reduced on day 1, 3, and 5 after surgery and the reduction was most significant in mild pain (P < .001). Opioids in analgesic pumps consumption was also significantly reduced and there was decreased incidence of adverse events such as nausea and vomiting (P = .026), respiratory inhibition (P = .027), and dizziness and headache (P = .028) in cardiovascular surgery patients after implementation of the ADP. Conclusions Improved effectiveness and safety were observed following the implementation of the ADP. Multimodal analgesic ADP methodology can be effectively used for postoperative pain management in patients undergoing cardiovascular surgery.
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Affiliation(s)
- Yue Yue
- School of Pharmacy, Qingdao University, Qingdao, Shandong, China
| | - Hongyan Ji
- Department of Pharmacy, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Shizhong Wang
- Department of Cardiovascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Huawei Cheng
- Department of Cardiovascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Rongmei Wang
- Department of Cardiovascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Haijun Qu
- Department of Pharmacy, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Jing Li
- Department of Pharmacy, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
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Burgess JR, Heneghan KC, Barot TG, Stulberg JJ. Surgeons' knowledge regarding perioperative pain management in patients with opioid use disorder: a survey among 260 members of the American College of Surgeons. Patient Saf Surg 2024; 18:9. [PMID: 38438902 PMCID: PMC10910809 DOI: 10.1186/s13037-024-00392-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 02/22/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Patients with opioid use disorder (OUD) are increasing, challenging surgeons to adjust post-operative pain management guidelines. A literature review identified limited information on how to best care for these patients. The purpose of this study was to determine surgical perioperative management of OUD, challenges, and support needed for optimal care. METHODS This study utilized an anonymous voluntary survey that was distributed to members of the American College of Surgeons through the association's electronic weekly newsletter. The survey was advertised weekly for three consecutive weeks. The survey included questions regarding surgeons' management of perioperative pain in patients with opioid use disorder and perceived barriers in treatment. RESULTS A total of 260 surgeons responded representing all specialties except ophthalmology. General surgery (66.5%) and plastic and reconstructive surgery (7.5%) represented the majority of responders. Ninety-five percent of surgeons reported treating a patient who used opioids in the past month and 86% encountered a patient with OUD. Nearly half (46%) reported being uncomfortable managing postoperative pain in patients with OUD. Most (67%) were not aware of any guidelines or standards pertaining to perioperative management of patients with OUD. While consultation was sought by 86% of surgeons, analyses identified lack of timely response and a lack of care coordination among specialists. Lack of knowledge and fear of harm (contributing further to addiction) were the most common themes. CONCLUSION Nearly half of surgeons report discomfort caring for patients with OUD with the vast majority involving a consulting service to assist with their care. Most surgeons believe that it would be helpful to have guidelines regarding the care of these patients. This provides an opportunity for increased education and training on the perioperative management of patients with OUD and further collaboration with addiction medicine, psychiatry and pain management colleagues.
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Affiliation(s)
- Jessica R Burgess
- Department of Surgery, Eastern Virginia Medical School, 6th Floor Hofheimer Hall, 825 Fairfax Avenue, Norfolk, VA, 23507, USA.
| | | | - Tarra G Barot
- Division of Education, American College of Surgeons, Chicago, IL, USA
| | - Jonah J Stulberg
- Department of Surgery, University of Texas Houston, Houston, TX, USA
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Javorski MJ, Rosinski BF, Shah S, Thompson MA, Streem D, Gordon SM, Insler S, Houghtaling PL, Griffin B, Blackstone EH, Unai S, Svensson LG, Pettersson GB, Elgharably H. Infective Endocarditis in Patients Addicted to Injected Opioid Drugs. J Am Coll Cardiol 2024; 83:811-823. [PMID: 38383096 DOI: 10.1016/j.jacc.2023.12.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/17/2023] [Accepted: 12/19/2023] [Indexed: 02/23/2024]
Abstract
BACKGROUND Persons who inject drugs and require surgery for infective endocarditis have 2 potentially lethal diseases. Current postoperative rehabilitation efforts seem ineffective in preventing loss to follow-up, injection drug use relapse (relapse), and death. OBJECTIVES The purpose of this study was to characterize drug use, psychosocial issues, surgical outcome, and postoperative addiction management, as well as loss to follow-up, relapse, and mortality and their risk factors. METHODS From January 2010 to June 2020, 227 persons who inject drugs, age 36 ± 9.9 years, underwent surgery for infective endocarditis at a quaternary hospital having special interest in developing addiction management programs. Postsurgery loss to follow-up, relapse, and death were assessed as competing risks and risk factors identified parametrically and by machine learning. CIs are 68% (±1 SE). RESULTS Heroin was the most self-reported drug injected (n = 183 [81%]). Psychosocial issues included homelessness (n = 56 [25%]), justice system involvement (n = 150 [66%]), depression (n = 118 [52%]), anxiety (n = 104 [46%]), and post-traumatic stress disorder (n = 33 [15%]). Four (1.8%) died in-hospital. Medication for opioid use disorder prescribed at discharge increased from 0% in 2010 to 100% in 2020. At 1 and 5 years, conditional probabilities of loss to follow-up were 16% (68% CI: 13%-22%) and 59% (68% CI: 44%-65%), relapse 32% (68% CI: 28%-34%) and 79% (68% CI: 74%-83%), and mortality 21% (68% CI: 18%-23%) and 68% (68% CI: 62%-72%). Younger age, heroin use, and lower education level were predictors of relapse. CONCLUSIONS Infective endocarditis surgery can be performed with low mortality in persons who inject drugs, but addiction is far more lethal. Risk of loss to follow-up and relapse require more effective addiction strategies without which this major loss to society will continue.
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Affiliation(s)
- Michael J Javorski
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Brad F Rosinski
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Shawn Shah
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Matthew A Thompson
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - David Streem
- Department of Psychiatry, Cleveland Clinic, Cleveland, Ohio, USA
| | - Steven M Gordon
- Department of Infectious Disease, Cleveland Clinic, Cleveland, Ohio, USA
| | - Steven Insler
- Department of Intensive Care and Resuscitation, Cleveland Clinic, Cleveland, Ohio, USA
| | - Penny L Houghtaling
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - Brian Griffin
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Eugene H Blackstone
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio, USA; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - Shinya Unai
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lars G Svensson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Gösta B Pettersson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Haytham Elgharably
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio, USA.
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Dewan KC, Milano CA. Infective Endocarditis, Substance Use Disorder, and Relapse: There Is No Silver Bullet. J Am Coll Cardiol 2024; 83:824-826. [PMID: 38383097 DOI: 10.1016/j.jacc.2023.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 02/23/2024]
Affiliation(s)
- Krish C Dewan
- Department of Thoracic and Cardiovascular Surgery, Duke University Medical Center, Durham, North Carolina, USA.
| | - Carmelo A Milano
- Department of Thoracic and Cardiovascular Surgery, Duke University Medical Center, Durham, North Carolina, USA
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Nalini M, Poustchi H, Roshandel G, Kamangar F, Khoshnia M, Gharavi A, Brennan P, Boffetta P, Dawsey SM, Abnet CC, Malekzadeh R, Etemadi A. Association Between Incident Type 2 Diabetes and Opium Use: Mediation by Body Mass and Adiposity. Am J Epidemiol 2023; 192:2050-2062. [PMID: 37552966 PMCID: PMC10691200 DOI: 10.1093/aje/kwad166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 05/26/2023] [Accepted: 08/03/2023] [Indexed: 08/10/2023] Open
Abstract
Opiates can affect glucose metabolism and obesity, but no large prospective study (to our knowledge) has investigated the association between long-term opium use, body mass index (BMI; weight (kg)/height (m)2), and incident type 2 diabetes mellitus (T2DM). We analyzed prospective data from 50,045 Golestan Cohort Study participants in Iran (enrollment: 2004-2008). After excluding participants with preexisting diseases, including diabetes, we used adjusted Poisson regression models to estimate incidence rate ratios (IRRs) and 95% confidence intervals (CIs) for T2DM in opium users compared with nonusers, using mediation analysis to assess the BMI-mediated association of opium use with incident T2DM. Of 40,083 included participants (mean age = 51.4 (standard deviation, 8.8) years; 56% female), 16% were opium users (median duration of use, 10 (interquartile range), 4-20) years). During follow-up (until January 2020), 5,342 incident T2DM cases were recorded, including 8.5% of opium users and 14.2% of nonusers. Opium use was associated with an overall decrease in incident T2DM (IRR = 0.83, 95% CI: 0.75, 0.92), with a significant dose-response association. Most (84.3%) of this association was mediated by low BMI or waist circumference, and opium use did not have a direct association with incident T2DM (IRR = 0.97, 95% CI: 0.87, 1.08). Long-term opium use was associated with lower incidence of T2DM, which was mediated by low body mass and adiposity.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Reza Malekzadeh
- Correspondence to Dr. Arash Etemadi, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20850 (e-mail: ); or Dr. Reza Malekzadeh, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Shariati Hospital, North Kargar Avenue, Tehran 14117-13135, Iran (e-mail: )
| | - Arash Etemadi
- Correspondence to Dr. Arash Etemadi, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20850 (e-mail: ); or Dr. Reza Malekzadeh, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Shariati Hospital, North Kargar Avenue, Tehran 14117-13135, Iran (e-mail: )
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Arora A, Cummins DD, Wague A, Mendelis J, Samtani R, McNeill I, Theologis AA, Mummaneni PV, Berven S. Preoperative medical assessment for adult spinal deformity surgery: a state-of-the-art review. Spine Deform 2023; 11:773-785. [PMID: 36811703 PMCID: PMC10261200 DOI: 10.1007/s43390-023-00654-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/21/2023] [Indexed: 02/24/2023]
Abstract
INTRODUCTION The purpose of this study is to provide a state-of-the-art review regarding risk factors for perioperative complications in adult spinal deformity (ASD) surgery. The review includes levels of evidence for risk factors associated with complications in ASD surgery. METHODS Using the PubMed database, we searched for complications, risk factors, and adult spinal deformity. The included publications were assessed for level of evidence as described in clinical practice guidelines published by the North American Spine Society, with summary statements generated for each risk factor (Bono et al. in Spine J 9:1046-1051, 2009). RESULTS Frailty had good evidence (Grade A) as a risk for complications in ASD patients. Fair evidence (Grade B) was assigned for bone quality, smoking, hyperglycemia and diabetes, nutritional status, immunosuppression/steroid use, cardiovascular disease, pulmonary disease, and renal disease. Indeterminate evidence (Grade I) was assigned for pre-operative cognitive function, mental health, social support, and opioid utilization. CONCLUSIONS Identification of risk factors for perioperative complications in ASD surgery is a priority for empowering informed choices for patients and surgeons and managing patient expectations. Risk factors with grade A and B evidence should be identified prior to elective surgery and modified to reduce the risk of perioperative complications.
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Affiliation(s)
- Ayush Arora
- Department of Orthopaedic Surgery, University of California - San Francisco UCSF, 500 Parnassus Ave, MUW320W, San Francisco, CA, 4143-0728, USA
| | - Daniel D Cummins
- Department of Orthopaedic Surgery, University of California - San Francisco UCSF, 500 Parnassus Ave, MUW320W, San Francisco, CA, 4143-0728, USA
| | - Aboubacar Wague
- Department of Orthopaedic Surgery, University of California - San Francisco UCSF, 500 Parnassus Ave, MUW320W, San Francisco, CA, 4143-0728, USA
| | - Joseph Mendelis
- Department of Orthopaedic Surgery, University of California - San Francisco UCSF, 500 Parnassus Ave, MUW320W, San Francisco, CA, 4143-0728, USA
| | - Rahul Samtani
- Department of Orthopaedic Surgery, University of California - San Francisco UCSF, 500 Parnassus Ave, MUW320W, San Francisco, CA, 4143-0728, USA
| | - Ian McNeill
- Department of Orthopaedic Surgery, University of California - San Francisco UCSF, 500 Parnassus Ave, MUW320W, San Francisco, CA, 4143-0728, USA
| | - Alekos A Theologis
- Department of Orthopaedic Surgery, University of California - San Francisco UCSF, 500 Parnassus Ave, MUW320W, San Francisco, CA, 4143-0728, USA
| | - Praveen V Mummaneni
- Department of Neurological Surgery, University California, San Francisco, San Francisco, CA, USA
| | - Sigurd Berven
- Department of Orthopaedic Surgery, University of California - San Francisco UCSF, 500 Parnassus Ave, MUW320W, San Francisco, CA, 4143-0728, USA.
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Kim NS, Lam AW, Golub IJ, Sheth BK, Vakharia RM, Saleh A, Razi AE. Opioid Use Disorder in Patients Undergoing Primary 1- to 2-Level Anterior Cervical Discectomy and Fusion Is Associated With Longer In-Hospital Lengths of Stay and Higher Rates of Readmissions, Complications, and Costs of Care. Global Spine J 2023; 13:1467-1473. [PMID: 34409880 PMCID: PMC10448104 DOI: 10.1177/21925682211037265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE To determine whether opioid use disorder (OUD) patients undergoing 1- to 2-level anterior cervical discectomy and fusion (1-2ACDF) have higher rates of: 1) in-hospital lengths of stay (LOS); 2) readmissions; 3) complications; and 4) costs. METHODS OUD patients undergoing primary 1-2ACDF were identified within the Medicare database and matched to a control cohort in a 1:5 ratio by age, sex, and medical comorbidities. The query yielded 80,683 patients who underwent 1-2 ACDF with (n = 13,448) and without (n = 67,235) OUD. Outcomes analyzed included in-hospital LOS, 90-day readmission rates, 90-day medical complications, and costs. Multivariate logistic regression analyses were used to calculate odds-ratios (OR) for medical complications and readmissions. Welch's t-test was used to test for significance for LOS and cost between the cohorts. An alpha value less than 0.002 was considered statistically significant. RESULTS OUD patients were found to have significantly longer in-hospital LOS compared to their counterparts (3.41 vs. 2.23-days, P < .0001), in addition to higher frequency and odds of requiring readmissions (21.62 vs. 11.57%; OR: 1.38, P < .0001). Study group patients were found to have higher frequency and odds of developing medical complications (0.88 vs. 0.19%, OR: 2.80, P < .0001) and incurred higher episode of care costs ($20,399.62 vs. $16,812.14, P < .0001). CONCLUSION The study can help to push orthopaedic surgeons in better managing OUD patients pre-operatively in terms of safe discontinuation and education of opioid drugs and their effects on complications, leading to more satisfactory outcomes.
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Affiliation(s)
- Nathan S. Kim
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York, NY, USA
- State University of New York (SUNY) Downstate, School of Medicine, Brooklyn, New York, NY, USA
| | - Aaron W. Lam
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York, NY, USA
| | - Ivan J. Golub
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York, NY, USA
| | - Bhavya K. Sheth
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York, NY, USA
| | - Rushabh M. Vakharia
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York, NY, USA
| | - Ahmed Saleh
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York, NY, USA
| | - Afshin E. Razi
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York, NY, USA
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Alalade E, Mpody C, Owusu-Bediako E, Tobias J, Nafiu OO. Prevalence and Outcomes of Opioid Use Disorder in Pediatric Surgical Patients: A Retrospective Cohort Study. Anesth Analg 2023; 136:308-316. [PMID: 35426848 DOI: 10.1213/ane.0000000000006038] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Chronic opioid use among adolescents is a leading preventable public health problem in the United States. Consequently, a sizable proportion of surgical patients in this age group may have a comorbid opioid use disorder (OUD). No previously published study has examined the prevalence of OUD and its impact on postoperative morbidity or mortality in the adolescent surgical population. Our objective was to investigate the prevalence of comorbid OUD and its association with surgical outcomes in a US adolescent surgical population. We hypothesized that OUD among adolescent surgical patients is on an upward trajectory and that the presence of OUD is associated with higher risk of postoperative morbidity or mortality. METHODS Using the pediatric health information system, we performed a 1:1 propensity score-matched, retrospective cohort study of adolescents (10-18 years of age) undergoing inpatient surgery between 2004 and 2019. The primary outcome was inpatient mortality. The secondary outcomes were surgical complications and postoperative infection. We also evaluated indicators of resource utilization, including mechanical ventilation, intensive care unit (ICU) admission, and postoperative length of stay (LOS). RESULTS Of 589,098 adolescents, 563 (0.1%) were diagnosed with comorbid OUD (563 were matched on OUD). The prevalence of OUD in adolescents undergoing surgery increased from 0.4 per 1000 cases in 2004 to 1.6 per 1000 cases in 2019, representing an average annual percent change (AAPC) of 9.7% (95% confidence interval [CI], 5.7-13.9; P value < .001). The overall postoperative mortality rate was 0.50% (n = 2941). On univariable analysis, mortality rate was significantly higher in adolescents with comorbid OUD than those without comorbid OUD (3.37% vs 0.50%; P < .001). Among propensity-matched pairs, comorbid OUD diagnosis was associated with an estimated 57% relative increase in the risk of surgical complications (adjusted relative risk [aRR], 1.57; 95% CI, 1.24-2.00; P < .001). The relative risk of postoperative infection was 2-fold higher in adolescents with comorbid OUD than in those without OUD (aRR, 2.02; 95% CI, 1.62-2.51; P < .001). Adolescents with comorbid OUD had an increased risk of ICU admission, mechanical ventilation, and extended postoperative LOS. CONCLUSIONS OUD is becoming increasingly prevalent in adolescents presenting for surgery. Comorbid OUD is an important determinant of surgical complications, postoperative infection, and resource utilization, underscoring the need to consider OUD as a critical, independent risk factor for postsurgical morbidity.
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Affiliation(s)
- Emmanuel Alalade
- From the Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio.,the Ohio State University College of Medicine, Columbus, Ohio
| | - Christian Mpody
- From the Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio.,the Ohio State University College of Medicine, Columbus, Ohio
| | - Ekua Owusu-Bediako
- From the Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio.,the Ohio State University College of Medicine, Columbus, Ohio
| | - Joseph Tobias
- From the Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio.,the Ohio State University College of Medicine, Columbus, Ohio
| | - Olubukola O Nafiu
- From the Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio.,the Ohio State University College of Medicine, Columbus, Ohio
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12
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Alalade E, Willer BL. Racial inequities in opioid use disorder management: can the anesthesiologist improve outcomes? Int Anesthesiol Clin 2023; 61:16-20. [PMID: 36480645 DOI: 10.1097/aia.0000000000000383] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Emmanuel Alalade
- Department of Pediatric Anesthesiology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia
- Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia
| | - Brittany L Willer
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio
- Department of Anesthesiology, The Ohio State University College of Medicine, Columbus, Ohio
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13
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Nursing Resources Linked to Postsurgical Outcomes for Patients With Opioid Use Disorder. ANNALS OF SURGERY OPEN 2022; 3:e185. [PMID: 36199489 PMCID: PMC9508985 DOI: 10.1097/as9.0000000000000185] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 06/14/2022] [Indexed: 11/28/2022] Open
Abstract
To determine whether better nursing resources (ie, nurse education, staffing, work environment) are each associated with improved postsurgical outcomes for patients with opioid use disorder (OUD).
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Lai H, Mubashir T, Shiwalkar N, Ahmad H, Balogh J, Williams G, Bauer C, Maroufy V. Association of pre-admission opioid abuse and/or dependence on major complications in traumatic brain injury (TBI) patients. J Clin Anesth 2022; 79:110719. [PMID: 35276593 DOI: 10.1016/j.jclinane.2022.110719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 02/23/2022] [Accepted: 02/28/2022] [Indexed: 11/17/2022]
Abstract
SETTING In the last few decades, an opioid related health crisis has been a challenging problem in many countries around the world, especially the United States. Better understanding of the association of pre-admission opioid abuse and/or dependence (POAD) on specific major complications in traumatic brain injury (TBI) patients can aid the medical team in improving patient care management and outcomes. STUDY OBJECTIVE Our goal is to assess and quantify the risk of POAD on in-hospital mortality and major complications in TBI patients. DESIGN We conducted a retrospective study and used the National Inpatient Sample (NIS) database from 2004 to 2015 to investigate the impact of POAD on in-hospital mortality and major complications in TBI patients. We utilized propensity score matching and conditional logistic regression models, adjusted with injury severity score (ISS) and comorbidities, to obtain the adjusted odds ratios (OR). MAIN RESULTS POAD TBI patients had lower risks of in-hospital mortality (OR 0.58; p < 0.001) and acute myocardial infarction (OR 0.53; p = 0.045), while a higher risk of respiratory (OR 1.59; p < 0.001) and neurologic complications (OR 2.54; p < 0.001), compared to non-POAD TBI patients. Additionally, POAD patients were significantly more likely to have sepsis (OR 2.16, p < 0.001), malnutrition (OR 1.56, p < 0.001), delirium (OR 2.81, p < 0.001), respiratory failure (OR 1.79, p < 0.001), and acute renal failure (OR 1.83, p < 0.001). POAD TBI patients had shorter length of hospital stay compared to non-POAD TBI patients (mean 8.0 vs 9.2 days, p < 0.001). CONCLUSIONS POAD TBI patients have a lower in-hospital mortality, shorter duration of hospitalization and a lower risk of acute myocardial infarction, while they are more likely to have respiratory failure, delirium, sepsis, malnutrition, and acute renal failure compared to TBI patients without POAD. Prospective study is warranted to further confirm these findings.
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Affiliation(s)
- Hongyin Lai
- Department of Biostatistics and Data Science, UTHealth School of Public Health, 1200 Pressler St, Houston, TX 77030, USA
| | - Talha Mubashir
- Department of Anesthesiology, UTHealth McGovern Medical School, 6410 Fannin St, Houston, TX 77030, USA
| | - Nimisha Shiwalkar
- Department of Anesthesiology and Critical Care, Zen Multispecialty Hospital and Research Center, Mumbai, India
| | - Hunza Ahmad
- Department of Anesthesiology, UTHealth McGovern Medical School, 6410 Fannin St, Houston, TX 77030, USA
| | - Julius Balogh
- Department of Anesthesiology, University of Arkansas for Medical Sciences, 4301 West Markham, #515, Little Rock, AR 72205, USA
| | - George Williams
- Department of Anesthesiology, UTHealth McGovern Medical School, 6410 Fannin St, Houston, TX 77030, USA
| | - Cici Bauer
- Department of Biostatistics and Data Science, UTHealth School of Public Health, 1200 Pressler St, Houston, TX 77030, USA
| | - Vahed Maroufy
- Department of Biostatistics and Data Science, UTHealth School of Public Health, 1200 Pressler St, Houston, TX 77030, USA.
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15
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Dewan KC, Zhou G, Koroukian SM, Petterson G, Bakaeen F, Roselli EE, Svensson LG, Gillinov AM, Johnston D, Soltesz EG. Opioid Use Disorder Increases Readmissions After Cardiac Surgery: A Call to Action. Ann Thorac Surg 2022; 114:1569-1576. [DOI: 10.1016/j.athoracsur.2022.02.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 02/25/2022] [Accepted: 02/25/2022] [Indexed: 11/29/2022]
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16
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French R, Aronowitz SV, Carthon JMB, Schmidt HD, Compton P. Interventions for hospitalized medical and surgical patients with opioid use disorder: A systematic review. Subst Abus 2022; 43:495-507. [PMID: 34283698 PMCID: PMC8991391 DOI: 10.1080/08897077.2021.1949663] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: Concurrent with the opioid overdose crisis there has been an increase in hospitalizations among people with opioid use disorder (OUD), with one in ten hospitalized medical or surgical patients having comorbid opioid-related diagnoses. We sought to conduct a systematic review of hospital-based interventions, their staffing composition, and their impact on outcomes for patients with OUD hospitalized for medical or surgical conditions. Methods: Authors searched PubMed MEDLINE, PsychINFO, and CINAHL from January 2015 through October 2020. The authors screened 463 titles and abstracts for inclusion and reviewed 96 full-text studies. Seventeen articles met inclusion criteria. Extracted were study characteristics, outcomes, and intervention components. Methodological quality was evaluated using the Methodological Quality Rating Scale. Results: Ten of the 17 included studies were controlled retrospective cohort studies, five were uncontrolled retrospective studies, one was a prospective quasi-experimental evaluation, and one was a secondary analysis of a completed randomized clinical trial. Intervention components and outcomes varied across studies. Outcomes included in-hospital initiation and post-discharge connection to medication for OUD, healthcare utilization, and discharge against medical advice. Results were mixed regarding the impact of existing interventions on outcomes. Most studies focused on linkage to medication for OUD during hospitalization and connection to post-discharge OUD care. Conclusions: Given that many individuals with OUD require hospitalization, there is a need for OUD-related interventions for this patient population. Interventions with the best evidence of efficacy facilitated connection to post-discharge OUD care and employed an Addiction Medicine Consult model.
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Affiliation(s)
- Rachel French
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA,Leonard Davis Institute for Health Economics, Philadelphia, Pennsylvania, USA
| | - Shoshana V. Aronowitz
- Leonard Davis Institute for Health Economics, Philadelphia, Pennsylvania, USA,National Clinician Scholars Program, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - J. Margo Brooks Carthon
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA,Leonard Davis Institute for Health Economics, Philadelphia, Pennsylvania, USA
| | - Heath D. Schmidt
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Peggy Compton
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Narayanan M, Alnahhal KI, Lingutla R, Irshad A, Iafrati M, Suarez L, Kumar S, Salehi P. Outcomes of Infrainguinal Bypass in Patients with Cannabis vs Opioid Use Disorder Outcomes of IIB in Patients with CUD vs OUD. Ann Vasc Surg 2021; 82:144-155. [PMID: 34902470 DOI: 10.1016/j.avsg.2021.10.069] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/22/2021] [Accepted: 10/26/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Marijuana and opioids are commonly used illicit drugs in the United States and their use continues to rise. Cannabis use disorder (CUD) and Opioid use disorder (OUD) are associated with adverse effects on public health and postoperative outcomes. However, their impact on vascular surgery, specifically infrainguinal bypass repair (IIB). is not well described in the literature. Therefore, our study aimed to assess perioperative outcomes in patients with CUD and OUD who underwent IIB. METHODS A retrospective analysis of the National Inpatient Sample database for the years 2005 to 2018 was performed. Using the International Classification of Diseases Clinical Modification, Ninth and Tenth revisions, patients who were diagnosed with peripheral artery disease and underwent IIB repair.were identified. Our primary outcome was the comparison of rates of in-hospital complications between the groups, and the secondary outcomes included analysis of total hospital charges and length of stay. A 1:1 propensity score matching (PSM) CUD and OUD patients to their control groups without the disease was conducted using the nearest-neighbor method. The matching was based on select patient demographics and comorbidities included in our analyses. RESULTS A total of 190,794 patients were identified: 972 patients with CUD and 682 patients with OUD. In the matched cohorts, patients with a diagnosis of CUD had a higher incidence of in-hospital cardiac complications (adjusted Odds Ratio [aOR], 1.76; 95% Confidence Interval [CI], 0.99 - 3.12) and acute kidney injury (AKI) (aOR, 1.51; CI, 1.09 - 2.08). Additionally, total hospital charges and mean length of stay were higher in the CUD group (P <.001). Those with OUD had a higher incidence of postoperative respiratory complications (aOR, 1.92; CI, 1.23 - 2.99), sepsis (aOR, 2.39; CI, 1.32 - 4.34), infection (aOR, 3.55; CI, 1.16 - 10.84), AKI (aOR, 2.11; CI,1.47-3.04), major amputations (aOR, 1.69; CI, 1.07 - 2.69), along with higher total charges and mean length of stay (P <.001). CONCLUSIONS Both CUD and OUD have increased incidence of postoperative complications following IIB. The OUD group had generally worse outcomes compared to patients with CUD. Both were associated with a substantial increase in total hospital charges and length of hospital stay. A further prospective study is warranted to provide better insight on the effects of substance use disorders on the procedure's short- and long-term outcomes.
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Affiliation(s)
- Meyyammai Narayanan
- Division of Vascular Surgery, Cardiovascular Center, Tufts Medical Center; Boston, MA
| | - Khaled I Alnahhal
- Division of Vascular Surgery, Cardiovascular Center, Tufts Medical Center; Boston, MA
| | | | - Ali Irshad
- Division of Vascular Surgery, Cardiovascular Center, Tufts Medical Center; Boston, MA
| | - Mark Iafrati
- Division of Vascular Surgery, Cardiovascular Center, Tufts Medical Center; Boston, MA
| | - Luis Suarez
- Division of Vascular Surgery, Cardiovascular Center, Tufts Medical Center; Boston, MA
| | - Shivani Kumar
- Division of Vascular Surgery, Cardiovascular Center, Tufts Medical Center; Boston, MA
| | - Payam Salehi
- Division of Vascular Surgery, Cardiovascular Center, Tufts Medical Center; Boston, MA.
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18
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Persistent Opioid Use After Open Aortic Surgery: Risk Factors, Costs, and Consequences. Ann Thorac Surg 2021; 112:1939-1945. [PMID: 33338481 PMCID: PMC9853230 DOI: 10.1016/j.athoracsur.2020.11.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/23/2020] [Accepted: 11/02/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND The incidence and financial impact of persistent opioid use (POU) after open aortic surgery is undefined. METHODS Insurance claim data from opioid-naïve patients who underwent aortic root replacement, ascending aortic replacement, or transverse arch replacement from 2011 to 2017 were evaluated. POU was defined as filling an opioid prescription in the perioperative period and between 90 and 180 days postoperatively. Postoperative opioid prescriptions, emergency department visits, readmissions, and health care costs were quantified. Multivariable logistic regression identified risk factors for POU, and quantile regression quantified the impact of POU on postoperative health care costs. RESULTS Among 3240 opioid-naïve patients undergoing open aortic surgery, 169 patients (5.2%) had POU. In the univariate analysis, patients with POU were prescribed more perioperative opioids (375 vs 225 morphine milligram equivalents, P < .001), had more emergency department visits (45.6% vs 25.4%, P < .001), and had significantly higher health care payments in the 6 months postoperatively ($10,947 vs $7223, P < .001). Independent risk factors for POU in the multivariable logistic regression included preoperative nicotine use and more opioids in the first perioperative prescription (all P < .05). After risk adjustment, POU was associated with a $2439 increase in total health care costs in the 6 months postoperatively. CONCLUSIONS POU is a challenge after open aortic operations and can have longer-term impacts on health care payments and emergency department visits in the 6 months after surgery. Strategies to reduce outpatient opioid use after aortic surgery should be encouraged when feasible.
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Opioid Use Disorder is Associated With Complications and Increased Length of Stay After Major Abdominal Surgery. Ann Surg 2021; 274:992-1000. [PMID: 31800489 DOI: 10.1097/sla.0000000000003697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to determine the impact of opioid use disorder (OUD) on perioperative outcomes after major upper abdominal surgeries. SUMMARY OF BACKGROUND DATA OUD, defined as dependence/abuse, is a national health epidemic. Its impact on outcomes after major abdominal surgery has not been well characterized. METHODS Patients who underwent elective esophagectomy, total/partial gastrectomy, major hepatectomy, and pancreatectomy were identified using the National Inpatient Sample (2003-2015). Propensity score matching by baseline characteristics was performed for patients with and without OUD. Outcomes measured were in-hospital complications, mortality, length of stay (LOS), and discharge disposition. RESULTS Of 376,467 patients, 1096 (0.3%) had OUD. Patients with OUD were younger (mean 53 vs 61 years, P < 0.001) and more often male (55.1% vs 53.2%, P < 0.001), black (15.0% vs 7.6%, P < 0.001), Medicaid beneficiaries (22.0% vs 6.4%, P < 0.001), and in the lowest income quartile (32.6% vs 21.3%, P < 0.001). They also had a higher rate of alcohol (17.2% vs 2.8%, P < 0.001) and nonopioid drug (2.2% vs 0.2%, P = 0.023) dependence/abuse. After matching (N = 1077 OUD, N = 2164 no OUD), OUD was associated with a higher complication rate (52.9% vs 37.3%, P < 0.001), including increased pain [odds ratio (OR) 3.5, P < 0.001], delirium (OR 3.0, P = 0.004), and pulmonary complications (OR 2.0, P = 0.006). Additionally, OUD was associated with increased LOS (mean 12.4 vs 10.6 days, P = 0.015) and nonroutine discharge (OR 1.6, P < 0.001). In-hospital mortality did not differ (OR 2.4, P = 0.10). CONCLUSION Patients with OUD more frequently experienced complications and increased LOS. Close postoperative monitoring may mitigate adverse outcomes.
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20
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Impact of insurance payer and socioeconomic status on type of autologous breast reconstruction. Surg Oncol 2021; 39:101661. [PMID: 34534730 DOI: 10.1016/j.suronc.2021.101661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 08/23/2021] [Accepted: 09/10/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Autologous breast reconstruction has evolved from more morbid procedures that sacrificed the abdominal muscle (the TRAM or transverse rectus abdominus muscle flap) to "perforator" flaps. Commercial insurers recognized the higher technical demand of perforator flaps by creating procedural codes with higher professional fees. This study examined whether procedure code discrepancies between insurance payers disproportionally incentivize perforator flaps among the commercially insured. METHODS Autologous breast reconstructions identified from the National Inpatient Sample (NIS) were subdivided into microvascular perforator (85.74, 85.75, 85.76), microvascular TRAM (85.73), and pedicled TRAM flaps (85.72). Demographics, comorbidities and access to care were compared. A logistic regression comparing microvascular reconstructions only was used to identify predictors for perforator flap reconstruction. RESULTS A total of 66,968 cases of autologous breast reconstruction were identified. Perforator flaps were more likely among the commercially insured (p < 0.001) and higher insurance quartiles (p < 0.001).When comparing microvascular reconstruction, perforator flaps were 1.72 (p < 0.001) times more likely among the commercially insured. As compared to the lowest income quartile, the fourth quartile had an odds ratio of 1.36 (p < 0.001) for perforator flap reconstruction. CONCLUSION The presence of a separate perforator flap billing code among the commercially insured may be exacerbating existing socioeconomic disparities in breast cancer reconstruction.
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Ranka S, Dalia T, Acharya P, Taduru SS, Pothuru S, Mahmood U, Stack B, Shah Z, Gupta K. Comparison of Hospitalization Trends and Outcomes in Acute Myocardial Infarction Patients With Versus Without Opioid Use Disorder. Am J Cardiol 2021; 145:18-24. [PMID: 33454349 DOI: 10.1016/j.amjcard.2020.12.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/21/2020] [Accepted: 12/29/2020] [Indexed: 11/18/2022]
Abstract
Discrepancies in medical care are well known to adversely affect patients with opioid abuse disorders (OUD), including management and outcomes of acute myocardial infarction (AMI) in patients with OUD. We used the National Inpatient Sample was queried from January 2006 to September 2015 to identify all patients ≥18 years admitted with a primary diagnosis of AMI (weighted N = 13,030; unweighted N = 2,670) and concomitant OUD. Patients using other nonopiate illicit drugs were excluded. Propensity matching (1:1) yielded 2,253 well-matched pairs in which intergroup comparison of invasive revascularization strategies and cardiac outcomes were performed. The prevalence of OUD patients with AMI over the last decade has doubled, from 163 (2006) to 326 cases (2015) per 100,000 admissions for AMI. The OUD group underwent less cardiac catheterization (63.2% vs 72.2%; p <0.001), percutaneous coronary intervention (37.0% vs 48.5%; p <0.001) and drug-eluting stent placement (32.3% vs 19.5%; p <0.001) compared with non-OUD. No differences in in-hospital mortality/cardiogenic shock were noted. Among subgroup of ST-elevation myocardial infarction patients (26.2% of overall cohort), the OUD patients were less likely to receive percutaneous coronary intervention (67.9% vs 75.5%; p = 0.002), drug-eluting stent (31.4% vs 47.9%; p <0.001) with a significantly higher mortality (7.4% vs 4.3%), and cardiogenic shock (11.7% vs 7.9%). No differences in the frequency of coronary bypass grafting were noted in AMI or its subgroups. In conclusion, OUD patients presenting with AMI receive less invasive treatment compared with those without OUD. OUD patients presenting with ST-elevation myocardial infarction have worse in-hospital outcomes with increased mortality and cardiogenic shock.
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Affiliation(s)
- Sagar Ranka
- Department of Cardiovascular Medicine, The University of Kansas Health System, University of Kansas School of Medicine, Kansas City, Kansas
| | - Tarun Dalia
- Department of Cardiovascular Medicine, The University of Kansas Health System, University of Kansas School of Medicine, Kansas City, Kansas
| | - Prakash Acharya
- Department of Cardiovascular Medicine, The University of Kansas Health System, University of Kansas School of Medicine, Kansas City, Kansas
| | - Siva Sagar Taduru
- Department of Cardiovascular Medicine, The University of Kansas Health System, University of Kansas School of Medicine, Kansas City, Kansas
| | | | - Uzair Mahmood
- Department of Medicine, The University of Kansas Health System, Kansas City, Kansas
| | - Brianna Stack
- Kansas University School of Medicine, Kansas City, Kansas
| | - Zubair Shah
- Department of Cardiovascular Medicine, The University of Kansas Health System, University of Kansas School of Medicine, Kansas City, Kansas
| | - Kamal Gupta
- Department of Cardiovascular Medicine, The University of Kansas Health System, University of Kansas School of Medicine, Kansas City, Kansas.
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Adejumo AC, Akanbi O, Alayo Q, Ejigah V, Onyeakusi NE, Omede OF, Pani L, Omole O. Predictors, rates, and trends of opioid use disorder among patients hospitalized with chronic pancreatitis. Ann Gastroenterol 2021; 34:262-272. [PMID: 33654369 PMCID: PMC7903576 DOI: 10.20524/aog.2021.0579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 09/23/2020] [Indexed: 12/15/2022] Open
Abstract
Background Patients with chronic pancreatitis (CP) suffer from pain and receive increased opioid prescriptions with a high risk of opioid use disorder (OUD). We studied the predictors, trends and outcomes of OUD among patients hospitalized with CP. Methods Records with CP (with/without OUD) were extracted from the Nationwide Inpatient Sample (NIS) 2012-2014, and the association of OUD with the burden of CP was calculated. We then charted the trends of OUD and its interaction with concomitant CP from NIS 2007-2014 (SAS 9.4). Results In the period 2012-2014, 4349 (4.99%) of the 87,068 CP patients had concomitant OUD, with higher risk among patients who were young, females, white vs. Hispanics, and individuals with chronic back pain, arthritis, non-opioid substance use, mental health disorders, and those hospitalized in urban centers. OUD was associated with a longer hospital stay (6.9 vs. 6.5 days, P=0.0015) but no significant difference in charges ($47,151 vs. $49,017, P=0.0598) or mortality (1.64% vs. 0.74%, P=0.0506). From 2007-2014, the average yearly rate of OUD was 174 cases per 10,000 hospitalizations (174/10,000), almost 3 times higher among CP vs. non-CP (479/10,000 vs. 173/10,000, P<0.001), and it increased from 2007 to 2014 (135/10,000 to 216/10,000, P<0.001). The yearly increase was 2.7 times higher among patients with CP vs. non-CP (29.9/10,000 vs. 11.3/10,000 hospitalizations/year, P<0.001). Conclusions CP is associated with higher rates and trends of OUD. Patients with CP at high risk of OUD may benefit from alternate analgesic regimens or surveillance for OUD when they are prescribed opioids.
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Affiliation(s)
- Adeyinka Charles Adejumo
- Department of Medicine, North Shore Medical Center, Salem, Massachusetts (Adeyinka Charles Adejumo, Ogorchukwu Faith Omede, Lydie Pani).,Department of Medicine, Tufts University Medical School, Boston, Massachusetts (Adeyinka Charles Adejumo, Ogorchukwu Faith Omede, Lydie Pani)
| | - Olalekan Akanbi
- Department of Medicine, University of Kentucky College of Medicine, Lexington Kentucky (Olalekan Akanbi)
| | - Quazim Alayo
- Department of Medicine, St. Luke's Hospital, Chesterfield, Missouri (Quazim Alayo)
| | - Victor Ejigah
- Department of Pharmaceutical Sciences, University of Massachusetts Lowell, Lowell, Massachusetts (Victor Ejigah)
| | - Nnaemeka Egbuna Onyeakusi
- Department of Anesthesiology, Case Western - MetroHealth campus, Cleveland, Ohio (Nnaemeka Egbuna Onyeakusi)
| | - Ogorchukwu Faith Omede
- Department of Medicine, North Shore Medical Center, Salem, Massachusetts (Adeyinka Charles Adejumo, Ogorchukwu Faith Omede, Lydie Pani).,Department of Medicine, Tufts University Medical School, Boston, Massachusetts (Adeyinka Charles Adejumo, Ogorchukwu Faith Omede, Lydie Pani)
| | - Lydie Pani
- Department of Medicine, North Shore Medical Center, Salem, Massachusetts (Adeyinka Charles Adejumo, Ogorchukwu Faith Omede, Lydie Pani).,Department of Medicine, Tufts University Medical School, Boston, Massachusetts (Adeyinka Charles Adejumo, Ogorchukwu Faith Omede, Lydie Pani)
| | - Oluwatosin Omole
- Department of Family Medicine, University Health System, San Antonio, Texas (Oluwatosin Omole), USA
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Brescia AA, Piazza JR, Jenkins JN, Heering LK, Ivacko AJ, Piazza JC, Dwyer-White MC, Peters SL, Cepero J, Brown BH, Longi FN, Monaghan KP, Bauer FW, Kathawate VG, Jafri SM, Webster MC, Kasperek AM, Garvey NL, Schwenzer C, Wu X, Lagisetty KH, Osborne NH, Waljee JF, Riba M, Likosky DS, Byrnes ME, Deeb GM. The Impact of Nonpharmacological Interventions on Patient Experience, Opioid Use, and Health Care Utilization in Adult Cardiac Surgery Patients: Protocol for a Mixed Methods Study. JMIR Res Protoc 2021; 10:e21350. [PMID: 33591291 PMCID: PMC7925147 DOI: 10.2196/21350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 11/13/2020] [Accepted: 11/17/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Despite pharmacological treatments, patients undergoing cardiac surgery experience severe anxiety and pain, which adversely affect outcomes. Previous work examining pediatric and nonsurgical adult patients has documented the effectiveness of inexpensive, nonpharmacological techniques to reduce anxiety and pain as well as health care costs and length of hospitalization. However, the impact of nonpharmacological interventions administered by a dedicated comfort coach has not been evaluated in an adult surgical setting. OBJECTIVE This trial aims to assess whether nonpharmacological interventions administered by a trained comfort coach affect patient experience, opioid use, and health care utilization compared with usual care in adult cardiac surgery patients. This study has 3 specific aims: assess the effect of a comfort coach on patient experience, measure differences in inpatient and outpatient opioid use and postoperative health care utilization, and qualitatively evaluate the comfort coach intervention. METHODS To address these aims, we will perform a prospective, randomized controlled trial of 154 adult cardiac surgery patients at Michigan Medicine. Opioid-naive patients undergoing first-time, elective cardiac surgery via sternotomy will be randomized to undergo targeted interventions from a comfort coach (intervention) versus usual care (control). The individualized comfort coach interventions will be administered at 6 points: preoperative outpatient clinic, preoperative care unit on the day of surgery, extubation, chest tube removal, hospital discharge, and 30-day clinic follow-up. To address aim 1, we will examine the effect of a comfort coach on perioperative anxiety, self-reported pain, functional status, and patient satisfaction through validated surveys administered at preoperative outpatient clinic, discharge, 30-day follow-up, and 90-day follow-up. For aim 2, we will record inpatient opioid use and collect postdischarge opioid use and pain-related outcomes through an 11-item questionnaire administered at the 30-day follow-up. Hospital length of stay, readmission, number of days in an extended care facility, emergency room, urgent care, and an unplanned doctor's office visit will be recorded as the primary composite endpoint defined as total days spent at home within the first 30 days after surgery. For aim 3, we will perform semistructured interviews with patients in the intervention arm to understand the comfort coach intervention through a thematic analysis. RESULTS This trial, funded by Blue Cross Blue Shield of Michigan Foundation in 2019, is presently enrolling patients with anticipated manuscript submissions from our primary aims targeted for the end of 2020. CONCLUSIONS Data generated from this mixed methods study will highlight effective nonpharmacological techniques and support a multidisciplinary approach to perioperative care during the adult cardiac surgery patient experience. This study's findings may serve as the foundation for a subsequent multicenter trial and broader dissemination of these techniques to other types of surgery. TRIAL REGISTRATION ClinicalTrials.gov NCT04051021; https://clinicaltrials.gov/ct2/show/NCT04051021. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/21350.
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Affiliation(s)
- Alexander A Brescia
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, United States
| | - Julie R Piazza
- Office of Patient Experience, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Jessica N Jenkins
- Department of Child and Family Life, CS Mott Children's Hospital, Michigan Medicine, Ann Arbor, MI, United States
| | - Lindsay K Heering
- Department of Child and Family Life, CS Mott Children's Hospital, Michigan Medicine, Ann Arbor, MI, United States
| | - Alexander J Ivacko
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - James C Piazza
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Molly C Dwyer-White
- Office of Patient Experience, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Stefanie L Peters
- Frankel Cardiovascular Center, Michigan Medicine, Ann Arbor, MI, United States
| | - Jesus Cepero
- Children and Women's Hospital, Michigan Medicine, Ann Arbor, MI, United States
| | - Bailey H Brown
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Faraz N Longi
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Katelyn P Monaghan
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Frederick W Bauer
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Varun G Kathawate
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Sara M Jafri
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, United States
| | - Melissa C Webster
- Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Amanda M Kasperek
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Nickole L Garvey
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Claudia Schwenzer
- Office of Patient Experience, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Xiaoting Wu
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Kiran H Lagisetty
- Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Nicholas H Osborne
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, United States
- Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Jennifer F Waljee
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, United States
- Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Michelle Riba
- Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Donald S Likosky
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, United States
| | - Mary E Byrnes
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, United States
- Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - G Michael Deeb
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
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Kuruppu S, Ghani M, Pritchard M, Harris M, Weerakkody R, Stewart R, Perera G. A prospective investigation of depression and adverse outcomes in patients undergoing vascular surgical interventions: A retrospective cohort study using a large mental health database in South London. Eur Psychiatry 2021; 64:e13. [PMID: 33455615 PMCID: PMC8057466 DOI: 10.1192/j.eurpsy.2021.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 12/07/2020] [Accepted: 01/07/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Patients with depression are more susceptible to cardiovascular illness including vascular surgeries. However, health outcomes after vascular surgery among patients with depression is unknown. This study aimed to investigate associations of depression with post-operative health outcomes for vascular surgical patients. METHODS A retrospective observational study was conducted using data from a large mental healthcare provider and linked national hospitalization data for the same south London geographic catchment. OPCS-4 codes were used to identify vascular procedures. Health outcomes were compared between those with/without depression including length of hospital stay (LOS), inpatient mortality, and 30 day emergency hospital readmissions. Predictors of these health outcomes were also assessed. RESULTS Vascular surgery was received by 9,267 patients, including 446 diagnosed with depression. Patients with depression had a higher risk of emergency admission for vascular surgery (odds ratio [OR] 1.28; 1.03, 1.59), longer index LOS (IRR 1.38; 1.33-1.42), and a higher risk of 30-day emergency readmission (OR 1.82; 1.35-2.47). Patients with depression had higher inpatient mortality after adjustment for sociodemographic status (1.51; 1.03, 2.23) but not on full adjustment, and had longer emergency readmission LOS (1.13; 1.04, 1.22) after adjustment for sociodemographic factors and cardiovascular disease. Correlates of vascular surgery hospitalization among patients with depression included admission through emergency route for longer LOS, inpatient mortality, and 30-day hospital readmission. CONCLUSION Patients with depression undergoing vascular surgery have substantially poorer health outcomes. Screening for depression prior to surgery might be indicated to target preventative measures.
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Affiliation(s)
- Sajini Kuruppu
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience. King’s College London. United Kingdom
| | - Marvey Ghani
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience. King’s College London. United Kingdom
| | - Megan Pritchard
- SLaM BRC Nucleus, South London and Maudsley NHS Foundation Trust. London. United Kingdom
| | - Matthew Harris
- Department of Vascular Surgery, The Royal Free Hospital, Pond Street, LondonNW3 2QG, United Kingdom
- King’s College Hospital NHS Foundation Trust, Denmark Hill, London, United Kingdom
| | - Ruwan Weerakkody
- Department of Vascular Surgery, The Royal Free Hospital, Pond Street, LondonNW3 2QG, United Kingdom
- King’s College Hospital NHS Foundation Trust, Denmark Hill, London, United Kingdom
| | - Robert Stewart
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience. King’s College London. United Kingdom
- SLaM BRC Nucleus, South London and Maudsley NHS Foundation Trust. London. United Kingdom
| | - Gayan Perera
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience. King’s College London. United Kingdom
- SLaM BRC Nucleus, South London and Maudsley NHS Foundation Trust. London. United Kingdom
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Ahmadinejad M, Karimi-Aliabadi H, Dehghan M, Mangolian P, Tajoddini S. Higher Morbidity and Mortality in Trauma Intensive Care Unit Patients with Opium Addiction. ADDICTION & HEALTH 2021; 13:1-8. [PMID: 33995954 PMCID: PMC8080177 DOI: 10.22122/ahj.v13i1.284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/03/2020] [Indexed: 12/03/2022]
Abstract
BACKGROUND Opium addiction is associated with multiple physical, psychological, and social problems. The aim of this study was to compare the risk of morbidity and mortality in opium-addicted and non-addicted trauma patients admitted to the intensive care units (ICUs) of trauma center of Kerman Province, Iran. METHODS In this cohort study, a total of 200 addict and non-addicted patients who were admitted due to trauma in ICUs of Shahid Bahonar Hospital in Kerman during 9 months of 2018 were included. Patients were compared in terms of mortality, incidence of pressure ulcers, incidence of organ failure, duration of mechanical ventilation, and duration of hospitalization. Data were analysed using Fisher's exact test and independent t-test at P < 0.05. FINDINGS Out of 197 examined patients, 161 (81.7%) individuals were men and 36 (18.3%) were women. Moreover, 98 (49.7%) patients had a history of opium abuse, while 99 (50.2%) patients had no history of opium addiction. The addicted and non-addicted groups had no significant differences in terms of age (P = 0.650) and gender (P = 0.580). In addicted patients, mortality, duration of mechanical ventilation (P = 0.027), the incidence of pressure ulcer, and organ failure were significantly higher (P < 0.001), but mean ICU stay and hospitalization time was the same in both groups. CONCLUSION The results of this study indicated higher mortality and morbidity in opium-addicted patients admitted to ICU than non-addicted ones. This suggests that various systems of the body are affected by opium and, in certain circumstances such as severe diseases, this will cause problems for patients. Therefore, experts should pay attention to complications and side effects of addiction in the management of critical patients with a history of opium abuse.
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Affiliation(s)
- Mehdi Ahmadinejad
- Neuroscience Research Center, Institute of Nuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Hakimeh Karimi-Aliabadi
- Neuroscience Research Center, Institute of Nuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Mahlagha Dehghan
- Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Parvin Mangolian
- Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Shahrad Tajoddini
- Department of Emergency Medicine, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
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Eiffert S, Nicol AL, Ellerbeck EF, Brooks JV, Roberts AW. Cancer survivorship and its association with perioperative opioid use for minor non-cancer surgery. Support Care Cancer 2020; 28:5763-5770. [PMID: 32215736 PMCID: PMC7529663 DOI: 10.1007/s00520-020-05420-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 03/17/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Reducing high-risk prescription opioid use after surgery has become a key strategy in mitigating the opioid crisis. Yet, despite their vulnerabilities, we know little about how cancer survivors use opioids for non-cancer perioperative pain compared to those with no history of cancer. The purpose was to examine the association of cancer survivorship with the likelihood of receiving perioperative opioid therapy for non-cancer minor surgery. METHODS Using 2007-2014 SEER-Medicare data for breast, colorectal, prostate, and non-cancer populations, we conducted retrospective cohort study of opioid-naïve Medicare beneficiaries who underwent one of six common minor non-cancer surgeries. Modified Poisson regression estimated the relative risk of receiving a perioperative opioid prescription associated with cancer survivorship compared to no history of cancer. Stabilized inverse probability of treatment weights were used to balance measurable covariates between cohorts. RESULTS We included 1486 opioid-naïve older adult cancer survivors and 3682 opioid-naïve non-cancer controls. Cancer survivorship was associated with a 5% lower risk of receiving a perioperative opioid prescription (95% confidence interval: 0.89, 1.00; p = 0.06) compared to no history of cancer. Cancer survivorship was not associated with the extent of perioperative opioid exposure. CONCLUSION Cancer survivors were slightly less likely to receive opioid therapy for non-cancer perioperative pain than those without a history of cancer. It is unclear if this reflects a reduced risk of opioid-related harms for cancer survivors or avoidance of appropriate perioperative pain therapy. Further examination of cancer survivors' experiences with and attitudes about opioids may inform improvements to non-cancer pain management for cancer survivors.
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Affiliation(s)
- Samantha Eiffert
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Andrea L Nicol
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Edward F Ellerbeck
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA
- The University of Kansas Cancer Center, Kansas City, KS, USA
| | - Joanna Veazey Brooks
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA
| | - Andrew W Roberts
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS, USA.
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA.
- The University of Kansas Cancer Center, Kansas City, KS, USA.
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27
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Boltunova A, Bailey C, Weinberg R, Ma X, Thalappillil R, Tam CW, White RS. Preoperative Opioid Use Disorder Is Associated With Poorer Outcomes After Coronary Bypass and Valve Surgery: A Multistate Analysis, 2007–2014. J Cardiothorac Vasc Anesth 2020; 34:3267-3274. [DOI: 10.1053/j.jvca.2020.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 05/31/2020] [Accepted: 06/03/2020] [Indexed: 11/11/2022]
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Madrigal J, Sanaiha Y, Hadaya J, Dhawan P, Benharash P. Impact of opioid use disorders on outcomes and readmission following cardiac operations. Heart 2020; 107:909-915. [PMID: 33122299 DOI: 10.1136/heartjnl-2020-317618] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/23/2020] [Accepted: 09/25/2020] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE While opioid use disorder (OUD) has been previously associated with increased morbidity and resource use in cardiac operations, its impact on readmissions is understudied. METHODS Patients undergoing coronary artery bypass grafting and valve repair or replacement, excluding infective endocarditis, were identified in the 2010-16 Nationwide Readmissions Database. Using International Classification of Diseases 9/10, we tabulated OUD and other characteristics. Multivariable regression was used to adjust for differences. RESULTS Of an estimated 1 978 276 patients who had cardiac surgery, 5707 (0.3%) had OUD. During the study period, the prevalence of OUD increased threefold (0.15% in 2010 vs 0.53% in 2016, parametric trend<0.001). Patients with OUD were more likely to be younger (54.0 vs 66.0 years, p<0.001), insured by Medicaid (28.2 vs 6.2%, p<0.001) and of the lowest income quartile (33.6 vs 27.1%, p<0.001). After multivariable adjustment, OUD was associated with decreased mortality (1.5 vs 2.7%, p=0.001). Although these patients had similar rates of overall complications (36.1 vs 35.1%, p=0.363), they had increased thromboembolic (1.3 vs 0.8%, p<0.001) and infectious (4.1 vs 2.8%, p<0.001) events, as well as readmission at 30 days (19.0 vs 13.2%, p<0.001). While patients with OUD had similar hospitalisation costs ($50 766 vs $50 759, p=0.994), they did have longer hospitalisations (11.4 vs 10.3 days, p<0.001). CONCLUSION The prevalence of OUD among cardiac surgical patients has steeply increased over the past decade. Although the presence of OUD was not associated with excess mortality at index hospitalisation, it was predictive of 30-day readmission. Increased attention to predischarge interventions and care coordination may improve outcomes in this population.
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Affiliation(s)
- Josef Madrigal
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
| | - Yas Sanaiha
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
| | - Joseph Hadaya
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
| | - Puneet Dhawan
- Department of Surgery, Los Angeles County Harbor-UCLA Medical Center, Torrance, California, USA
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
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29
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Zhang Z, Wang H, Wang Y, Luo Q, Yuan S, Yan F. Risk of Postoperative Hyperalgesia in Adult Patients with Preoperative Poor Sleep Quality Undergoing Open-heart Valve Surgery. J Pain Res 2020; 13:2553-2560. [PMID: 33116797 PMCID: PMC7568632 DOI: 10.2147/jpr.s272667] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 08/26/2020] [Indexed: 12/14/2022] Open
Abstract
Purpose Studies have reported that preoperative poor sleep quality could decrease the pain threshold in patients undergoing noncardiac surgery. However, the risk of postoperative hyperalgesia (HA) in cardiac surgery patients with preoperative poor sleep quality remains unclear. Patients and Methods We retrospectively collected clinical data from patients undergoing open-heart valve surgery between May 1 and October 31, 2019, in Fuwai Hospital (Beijing). We assessed preoperative sleep quality and postoperative pain severity using the Pittsburgh sleep quality index (PSQI) and numerical pain rating scale (NPRS), respectively. A PSQI of six or greater was considered to indicate poor sleep quality, and a NPRS of four or greater was considered to indicate HA. Multivariable logistic regression analysis was used to study the risk of postoperative HA in patients with preoperative poor sleep quality. Results We divided 214 eligible patients into two groups based on postoperative HA; HA group: n=61 (28.5%) and nonHA group: n=153 (71.5%). Compared with nonHA patients, patients with postoperative HA showed a higher percentage of history of smoking, 17 (11.1%) vs 15 (24.6%) and alcohol abuse, 5 (3.3%) vs 6 (9.8%), higher intraoperative dose of sufentanil (median, 1.02 vs 1.12 μg/kg/h), and longer duration of ventilation with tracheal catheter (median, 760 vs 934 min). Preoperative poor sleep quality was associated independently with an increased risk of postoperative HA (adjusted odds ratio [AOR]: 2.66; 95%CI: 1.31–5.39, P=0.007). Stratification by history of smoking revealed a stronger risk of postoperative HA in nonsmoking patients with preoperative poor sleep quality (AOR: 3.40; 95%CI: 1.51–7.66, P=0.003). No risk was found in patients who had history of smoking (AOR: 0.83; 95%CI: 0.14–4.75, P=0.832). Conclusion Preoperative poor sleep quality is an independent risk factor for postoperative HA in adult patients undergoing open-heart valve surgery who had no history of smoking.
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Affiliation(s)
- Zhe Zhang
- Department of Anesthesiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Hongbai Wang
- Department of Anesthesiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yuefu Wang
- Department of Anesthesiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Qipeng Luo
- Department of Anesthesiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Su Yuan
- Department of Anesthesiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Fuxia Yan
- Department of Anesthesiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
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30
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Kim JH, Fine DR, Li L, Kimmel SD, Ngo LH, Suzuki J, Price CN, Ronan MV, Herzig SJ. Disparities in United States hospitalizations for serious infections in patients with and without opioid use disorder: A nationwide observational study. PLoS Med 2020; 17:e1003247. [PMID: 32764761 PMCID: PMC7413412 DOI: 10.1371/journal.pmed.1003247] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 07/08/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Patients with opioid use disorder (OUD) who are hospitalized for serious infections requiring prolonged intravenous antibiotics may face barriers to discharge, which could prolong hospital length of stay (LOS) and increase financial burden. We investigated differences in LOS, discharge disposition, and charges between hospitalizations for serious infections in patients with and without OUD. METHODS AND FINDINGS We utilized the 2016 National Inpatient Sample-a nationally representative database of all discharges from US acute care hospitals. The population of interest was all hospitalizations for infective endocarditis, epidural abscess, septic arthritis, or osteomyelitis. The exposure was OUD, and the primary outcome was LOS until discharge, assessed by using a competing risks analysis to estimate adjusted hazard ratios (aHRs). Adjusted odds ratio (aOR) of discharge disposition and adjusted differences in hospital charges were also reported. Of 95,470 estimated hospitalizations for serious infections (infective endocarditis, epidural abscess, septic arthritis, and osteomyelitis), the mean age was 49 years and 35% were female. 46% had Medicare (government-based insurance coverage for people age 65+ years), and 70% were non-Hispanic white. After adjustment for potential confounders, OUD was associated with a lower probability of discharge at any given LOS (aHR 0.61; 95% CI 0.59-0.63; p < 0.001). OUD was also associated with lower odds of discharge to home (aOR 0.38; 95% CI 0.33-0.43; p < 0.001) and higher odds of discharge to a post-acute care facility (aOR 1.85; 95% CI 1.57-2.17; p < 0.001) or patient-directed discharge (also referred to as "discharge against medical advice") (aOR 3.47; 95% CI 2.80-4.29; p < 0.001). There was no significant difference in average total hospital charges, though daily hospital charges were significantly lower for patients with OUD. Limitations include the potential for unmeasured confounders and the use of billing codes to identify cohorts. CONCLUSIONS Our findings suggest that among hospitalizations for some serious infections, those involving patients with OUD were associated with longer LOS, higher odds of discharge to post-acute care facilities or patient-directed discharge, and similar total hospital charges, despite lower daily charges. These findings highlight opportunities to improve care for patients with OUD hospitalized with serious infections, and to reduce the growing associated costs.
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Affiliation(s)
- June-Ho Kim
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Ariadne Labs, Brigham and Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Danielle R. Fine
- Harvard Medical School, Boston, Massachusetts, United States of America
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Lily Li
- Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Simeon D. Kimmel
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, Massachusetts, United States of America
- Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, Massachusetts, United States of America
| | - Long H. Ngo
- Harvard Medical School, Boston, Massachusetts, United States of America
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Joji Suzuki
- Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Psychiatry, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Christin N. Price
- Harvard Medical School, Boston, Massachusetts, United States of America
- Brigham and Women’s Physicians Organization, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Matthew V. Ronan
- Department of Medicine, West Roxbury VA Medical Center, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, United States of America
| | - Shoshana J. Herzig
- Harvard Medical School, Boston, Massachusetts, United States of America
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
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French R, McHugh MD, Lake E, Brooks Carthon JM. A Systematic Review of Care Needs for Surgical Patients with Chronic Opioid Use. MEDSURG NURSING : OFFICIAL JOURNAL OF THE ACADEMY OF MEDICAL-SURGICAL NURSES 2020; 29:245-254. [PMID: 34079200 PMCID: PMC8168975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
An understudied aspect of the opioid crisis with implications for nursing is care of hospitalized surgical patients with chronic opioid use. Care needs of these patients are not well understood. This systematic review identified salient care needs and explored the role of nursing in meeting these needs.
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Affiliation(s)
- Rachel French
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, PA
| | - Matthew D McHugh
- Center for Health Outcomes & Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, PA
| | - Eileen Lake
- Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia, PA
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Yaranov DM, Kendall K, Miracle K, Rosenquist R, Jimenez X, Shelkay S, Morales R, Williams JB, Taylor DO, Soltesz E, Tang WHW. Multimodal analgesia using opioid-sparing regimen in patients undergoing left ventricular assist device implantation. J Heart Lung Transplant 2020; 39:977-979. [PMID: 32532570 DOI: 10.1016/j.healun.2020.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 05/14/2020] [Accepted: 05/20/2020] [Indexed: 10/24/2022] Open
Affiliation(s)
- Dmitry M Yaranov
- Department of Cardiovascular Medicine, Kaufman Center for Heart Failure Treatment and Recovery, Heart, Vascular & Thoracic Institute, Cleveland, Ohio
| | | | - Kimberly Miracle
- Department of Cardiovascular Medicine, Kaufman Center for Heart Failure Treatment and Recovery, Heart, Vascular & Thoracic Institute, Cleveland, Ohio
| | - Richard Rosenquist
- Departments of Pain Management, Anesthesiology Institute, Cleveland, Ohio
| | - Xavier Jimenez
- Center for Neurological Restoration, Neurological Institute Cleveland Clinic, Cleveland, Ohio
| | | | - Rommel Morales
- Ohio State University School of Medicine, Columbus, Ohio
| | | | - David O Taylor
- Department of Cardiovascular Medicine, Kaufman Center for Heart Failure Treatment and Recovery, Heart, Vascular & Thoracic Institute, Cleveland, Ohio
| | - Edward Soltesz
- Department of Cardiovascular Medicine, Kaufman Center for Heart Failure Treatment and Recovery, Heart, Vascular & Thoracic Institute, Cleveland, Ohio
| | - W H Wilson Tang
- Department of Cardiovascular Medicine, Kaufman Center for Heart Failure Treatment and Recovery, Heart, Vascular & Thoracic Institute, Cleveland, Ohio
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Clement KC, Canner JK, Whitman GJR, Lawton JS, Grant MC, Sussman MS. New Persistent Opioid Use After Aortic and Mitral Valve Surgery in Commercially Insured Patients. Ann Thorac Surg 2020; 110:829-835. [PMID: 32004502 DOI: 10.1016/j.athoracsur.2019.12.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 11/15/2019] [Accepted: 12/09/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Deaths from prescription opioid overdose are dramatically increasing. This study evaluates the incidence, risk factors, and cost of new persistent opioid use after aortic valve replacement, mitral valve replacement, and mitral valve repair. METHODS Insurance claims from commercially insured patients who underwent aortic valve replacement, mitral valve replacement, mitral valve repair, or aortic valve replacement and mitral valve replacement/repair from 2014 to 2016 were evaluated. New persistent opioid use was defined as opioid-naive patients who filled an opioid prescription in the perioperative period and filled opioid prescriptions between 90 and 180 days postoperatively. Multivariable logistic regression identified risk factors for new persistent opioid use. Quantile regression evaluated the impact of new persistent opioid use on total healthcare payments in the 6 months after discharge. RESULTS Among 3404 opioid-naive patients undergoing aortic valve replacement, mitral valve replacement, or mitral valve repair, 188 (5.5%) had new persistent opioid use. Living in the southern United States (odds ratio, 1.89; 95% confidence interval, 1.35-2.63; P < .001) and increased opioids prescribed in the perioperative period (odds ratio, 1.009; 95% confidence interval, 1.006-1.012; P < .001) were independently associated with new persistent opioid use. After risk adjustment, new persistent opioid use was associated with a 2-fold higher number of emergency department visits (odds ratio, 2.21; 95% confidence interval, 1.61-3.03; P < .001) and a $5422 increase in healthcare payments in the 6 months after discharge. CONCLUSIONS New persistent opioid use is a significant and costly complication after aortic and mitral valve surgery in privately insured patients. Variation in regional susceptibility and opioid prescribing suggests that standardization may help prevent this complication.
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Affiliation(s)
- Kathleen C Clement
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Joseph K Canner
- Johns Hopkins Surgery Center for Outcomes Research, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Glenn J R Whitman
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jennifer S Lawton
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael C Grant
- Department of Anesthesia and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Marc S Sussman
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Nelson DB, Niu J, Mitchell KG, Sepesi B, Hofstetter WL, Antonoff MB, Giordano SH, Mehran RJ, Rice DC. Persistent Opioid Use Among the Elderly After Lung Resection: A SEER-Medicare Study. Ann Thorac Surg 2020; 109:194-202. [DOI: 10.1016/j.athoracsur.2019.06.095] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 05/17/2019] [Accepted: 06/24/2019] [Indexed: 10/26/2022]
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Wurcel AG, Boll G, Burke D, Khetarpal R, Warner PJ, Tang AM, Warner KG. Impact of Substance Use Disorder on Midterm Mortality After Valve Surgery for Endocarditis. Ann Thorac Surg 2019; 109:1426-1432. [PMID: 31630767 DOI: 10.1016/j.athoracsur.2019.09.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 08/01/2019] [Accepted: 09/03/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Fueled by the burgeoning opioid epidemic, valve surgeries for substance use disorder-related infective endocarditis (SUD-IE) are increasing. The impact of substance use disorder on postvalve replacement morbidity needs further investigation. METHODS We queried The Society of Thoracic Surgeons Adult Cardiac Surgery Database for all valve surgeries for infective endocarditis at Tufts Medical Center (2002-2016) and collected demographic and disease-related data, including timing of mortality subclassified as short-term (<6 months including operative), midterm (6 months to 5 years), and extended-term (>5 years). Patients with documentation of illicit drug use before the operation were considered to have SUD-IE. Deaths were confirmed through review of medical record and matching with the Massachusetts Vital Statistics Database. We performed univariate and multivariate proportional hazard regressions examining the impact of substance use disorder mortality in people who received a valve replacement. RESULTS In the cohort of 228 patients, 80 (35%) had SUD-IE. Eight-six people (38%) died, and overall mortality was higher in people with SUD-IE compared with non-SUD-IE (48% vs 32%, P = .025). SUD-IE was associated with a higher risk of overall mortality (adjusted hazard ratio, 2.41; 95% confidence interval, 1.38-4.20; P = .002). Although the difference between short-term or extended-term mortality was not significant, SUD-IE was associated with increased frequency of midterm mortality (53% vs 31%, P = .003). CONCLUSIONS Our data reflect high rates of postvalve surgery morbidity and mortality in people with SUD-IE at a tertiary care center. The midterm postoperative period is a vulnerable period for people with SUD-IE worthy of further investigation.
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Affiliation(s)
- Alysse G Wurcel
- Division of Geographic Medicine and Infectious Diseases, Department of Medicine, Tufts Medical Center, Boston, Massachusetts; Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts.
| | - Griffin Boll
- Department of Surgery, Tufts Medical Center, Boston, Massachusetts
| | - Deirdre Burke
- Division of Geographic Medicine and Infectious Diseases, Department of Medicine, Tufts Medical Center, Boston, Massachusetts
| | - Rani Khetarpal
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | - Patrick J Warner
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | - Alice M Tang
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | - Kenneth G Warner
- Department of Surgery, Tufts Medical Center, Boston, Massachusetts
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Perioperative outcomes among chronic opioid users who receive lobectomy for non-small cell lung cancer. J Thorac Cardiovasc Surg 2019; 159:691-702.e5. [PMID: 33003262 DOI: 10.1016/j.jtcvs.2019.09.059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 08/21/2019] [Accepted: 09/04/2019] [Indexed: 01/14/2023]
Abstract
OBJECTIVE We sought to identify whether chronic opioid users are at increased risk for complications or hospital readmission following lobectomy for non-small cell lung cancer. METHODS The National Cancer Institute Surveillance, Epidemiology, and End Results-Medicare database was queried to identify patients older than age 65 years who received a lobectomy for non-small cell lung cancer. Chronic opioid users were identified through Medicare Part D records and were defined as those with >120 cumulative days of opioid supply for the year before surgery. A systematic 1:2 propensity matching was performed among chronic opioid users. RESULTS Six thousand four hundred thirty-seven patients were identified, among whom 3627 (56%) were opioid naïve, 1866 (29%) were intermittent opioid users, and 944 (15%) were chronic opioid users. After propensity matching, 30-day mortality and 90-day mortality were nearly 2-fold higher among chronic opioid users compared with nonchronic users. In addition, length of stay and hospital charges were increased among chronic opioid users (median, 6 vs 7 days and mean increase, $12,526, respectively). Multivariable analysis revealed that intermittent opioid users and chronic opioid users were associated with an increased risk of 90-day hospital readmission compared with opioid-naïve patients (odds ratio, 1.35; 95% confidence interval, 1.07-1.71 and odds ratio, 1.72; 95% confidence interval, 1.40-2.12, respectively), predominantly burdened by infectious, renal, and pulmonary causes. CONCLUSIONS Patients who chronically use opioids before lobectomy represent high-risk patients. The risk of 30- and 90-day mortality, length of stay, hospital charges, and 90-day readmission after lobectomy among chronic opioid users are substantially elevated.
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Mori M, Brown KJ, Geirsson A. Understanding Limitations of the National Inpatient Sample to Facilitate its Proper Use. JAMA Surg 2019; 154:881-882. [DOI: 10.1001/jamasurg.2019.1172] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Makoto Mori
- Section of Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Kelly J. Brown
- Section of Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Arnar Geirsson
- Section of Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut
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Dewan KC, Navale SM, Soltesz EG. Understanding Limitations of the National Inpatient Sample to Facilitate its Proper Use-Reply. JAMA Surg 2019; 154:882. [PMID: 31141127 DOI: 10.1001/jamasurg.2019.1173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Krish C Dewan
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Suparna M Navale
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Edward G Soltesz
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
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