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Cizik AM, Zhang C, Presson AP, Randall D, Kazmers NH. Linking QuickDASH and PROMIS Upper-Extremity Computer-Adaptive Test Scores in Hand Surgery: A Crosswalk Study. J Hand Surg Am 2024; 49:664-674. [PMID: 38795102 DOI: 10.1016/j.jhsa.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/22/2024] [Accepted: 04/10/2024] [Indexed: 05/27/2024]
Abstract
PURPOSE Assessment of patient-reported outcome measures (PROMs) for hand and upper-extremity surgery patients using measures such as the Quick Disabilities of the Arm, Shoulder, and Hand (qDASH), as well as general measures including the Patient-Reported Outcomes Measurement Information System Upper Extremity Physical Function domain via a Computer-Adaptive Test (PROMIS UE CAT), has become commonplace. The aim of this study was to link, for crosswalking, the qDASH measure to both versions of the PROMIS UE CAT (v1.2 and v2.0). METHODS We included 18,944 hand and upper-extremity patients who completed both versions of the PROMIS UE CAT and the qDASH at the same clinical encounter. Shoulder pathology was excluded. Score linkage was performed using the R package equate, and multiple equating models (linear regression, identity, mean, linear, equipercentile, and circle-arc models) were used to establish crosswalk tables. RESULTS Mean qDASH and PROMIS UE CAT v1.2 scores were 38.2 (SD = 23.1) and 36.6 (SD = 9.8), respectively. Mean qDASH and PROMIS UE CAT v2.0 scores were 37.3 (SD = 21.8) and 38.3 (SD = 10.4), respectively. Pearson correlations had very strong linear relationships between the qDASH and the PROMIS UE CAT v1.2 and PROMIS UE CAT v2.0 (r = -0.83 [-0.84, -0.92] and r = -0.80 [-0.81, -0.80], respectively). For the equipercentile equating models, the intraclass correlation coefficient (ICC) had very strong positive relationships to linking measures with ICC = 0.85 (0.84, 0.86) for the qDASH-UE CAT v1.2 crosswalk and ICC = 0.83 (0.82, 0.84) for the qDASH-UE CAT v2.0 crosswalk. CONCLUSIONS The linkages establish crosswalk tables using equipercentile equating models to convert the PROMIS UE CAT v1.2 and v2.0 scores to the qDASH and vice versa. CLINICAL RELEVANCE This study provides crosswalk tables for commonly collected PROMs in hand surgery, increasing the comparability of results between centers using different PROMs to study the same conditions or treatments.
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Affiliation(s)
- Amy M Cizik
- Department of Orthopaedics, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT.
| | - Chong Zhang
- Division of Epidemiology, Department of Internal Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT
| | - Angela P Presson
- Division of Epidemiology, Department of Internal Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT
| | - Dustin Randall
- Department of Orthopaedics, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT
| | - Nikolas H Kazmers
- Department of Orthopaedics, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT
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Rogers MJ, Daryoush JR, Zhang C, Cizik A, Presson AP, Kazmers NH. Crosswalk between the PROMIS physical function CAT and PROMIS upper extremity CAT v1.2 in a hand surgery population. J Patient Rep Outcomes 2024; 8:53. [PMID: 38816587 PMCID: PMC11139816 DOI: 10.1186/s41687-024-00736-6] [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: 12/11/2023] [Accepted: 05/20/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND There is no gold standard patient-reported outcome measure (PROM) in hand surgery. As a result, a diverse array of PROM instruments have been utilized across centers over time. Lack of score interchangeability limits the ability to compare or conglomerate scores when new instruments are introduced. Our aim was to develop a linkage for the PROMIS UE CAT v1.2 and PROMIS PF CAT scores and develop crosswalk tables for interconversion between these PROMs. METHODS Retrospective review was conducted to identify adult (≥ 18y) patients seen by orthopaedic hand surgeons at a single academic tertiary care hospital who had completed PROMIS UE CAT v1.2 and PROMIS PF CAT score at the same visit. For those with multiple visits, only one randomly selected visit was included in the analyses. Pearson's correlation was calculated to determine the linear relationship between the scores. Linkage from PF to UE was performed utilizing several commonly utilized equating models (identity, mean, linear, equipercentile and circle-arc methods). The performance of the models was assessed using intraclass correlation (ICC) between observed PROMIS UE CAT v1.2 and estimated PROMIS UE CAT v1.2 scores generated using the model as well as Root Mean Square Error (RMSE). The model chosen as the 'best' was further assessed for population invariance using root expected mean squared difference (REMSD) where < 0.08 were considered good. RESULTS Of 10,081 included patients, mean age was 48.3 (SD = 17.0), and 54% were female (5,477/10,081). Mean UE CAT v1.2 and PF CAT scores were 37 (SD = 9.8) and 46 (SD = 10.0), respectively. There was a strong correlation between the scores (Pearson correlation r = 0.70). All methods performed acceptably (ICC ≥ 0.66 and RMSE < = 7.52 for all). The equipercentile method had the highest ICC (ICC = 0.70 (95% CI 0.69-0.71)) while the mean and circle arc methods had the lowest RMSE. The circle arc method is the most reliable with the smallest standard error and has satisfactory population invariance across age group (REMSD 0.065) and sex (REMSD 0.036). CONCLUSIONS Crosswalk tables to be used for bidirectional conversion between scores were created. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Miranda J Rogers
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, 48109, USA
- Department of Orthopaedic Surgery, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Joshua R Daryoush
- Department of Orthopaedic Surgery, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Chong Zhang
- Division of Public Health, University of Utah, Salt Lake City, UT, 84108, USA
| | - Amy Cizik
- Department of Orthopaedic Surgery, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Angela P Presson
- Division of Public Health, University of Utah, Salt Lake City, UT, 84108, USA
| | - Nikolas H Kazmers
- Department of Orthopaedic Surgery, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA.
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Siebert MJ, Roca H, Maughan G, Monson HW, Kazmers NH. Evaluating Factors Associated With Patient-Perceived Applicability of the QuickDASH Survey in Reflecting Their Goals of Care Prior to Hand Surgery. J Hand Surg Am 2024; 49:35-41. [PMID: 37952144 DOI: 10.1016/j.jhsa.2023.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 08/22/2023] [Accepted: 09/06/2023] [Indexed: 11/14/2023]
Abstract
PURPOSE Patient-reported outcome measures intend to capture patients' perspectives on their health status. However, the patient-perceived applicability of many of these patient-reported outcome measures is unknown. We hypothesized that patients experiencing greater upper extremity disability and greater pain interference would be more likely to report that the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire (QuickDASH) survey content is responsive to their daily lives and goals in seeking surgical care. METHODS Adult preoperative hand surgery patients at a single tertiary academic center were recruited prospectively. QuickDASH, Patient-Reported Outcomes Measurement Information System Pain Interference computerized-adaptive-testing, and the Godin Leisure-Time Exercise Questionnaire (GLTEQ)-a validated adult physical activity level metric-data were collected. The following two Likert response questions were also asked: question (1) "How applicable is the above questionnaire to your treatment goals for your upper extremity condition?" and question (2) "How applicable is the overall questionnaire to your daily life?" Multivariable binary logistic regression was performed to define the factors associated with patients reporting that the survey was "very applicable." RESULTS Of the 133 included patients, the mean age was 49 ± 18 years, 40% were women, and the mean GLTEQ score was 54.1 ± 5.5 (consistent with a high level of activity). For questions 1 and 2, 32% and 29% of the patients reported that QuickDASH was "very applicable," respectively. The multivariable model demonstrated that for every 10-point increase in QuickDASH, there was a 45% to 49% greater odds of respondents reporting that the survey was "very applicable," and for every 5-point increase in pain interference computerized-adaptive-testing, the odds increased by 55% to 70%. No association with GLTEQ was observed. CONCLUSIONS Patients with greater upper extremity disability and pain interference were more likely to find the QuickDASH content to be applicable to their daily lives and goals in seeking surgical care. CLINICAL RELEVANCE These findings suggest that QuickDASH may not be an optimal instrument when evaluating upper extremity function in cohorts with mild disability and low pain interference.
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Affiliation(s)
| | - Hernan Roca
- Department of Orthopaedics, University of Utah, Salt Lake City, UT
| | - Gretchen Maughan
- Department of Orthopaedics, University of Utah, Salt Lake City, UT
| | - Haley W Monson
- Department of Orthopaedics, University of Utah, Salt Lake City, UT
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Clawson JW, Rogers MJ, Stockburger C, Ou Z, Presson AP, Kazmers NH. Evaluation of Preoperative Factors Affecting Midterm Patient-Reported Outcomes Following Ligament Reconstruction Tendon Interposition: A Prognostic Study. J Hand Surg Am 2023; 48:226-235. [PMID: 36593153 PMCID: PMC9991955 DOI: 10.1016/j.jhsa.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 10/05/2022] [Accepted: 11/02/2022] [Indexed: 01/01/2023]
Abstract
PURPOSE The aim of this study was to evaluate the prognostic value of preoperative patient-reported outcomes as predictors of functional improvement following ligament reconstruction tendon interposition. We hypothesized that high levels of preoperative pain interference (PI) and upper-extremity disability are associated with lower magnitudes of functional improvement ≥1 year after surgery on the shortened version of the Disabilities of the Arm, Shoulder, and Hand (QuickDASH) (primary outcome) and Patient-Reported Outcomes Measurement Information System Upper Extremity (UE) Computer Adaptive Test (CAT) (UE CAT) v1.2 (secondary outcome). METHODS Adult patients who underwent ligament reconstruction tendon interposition between February 2014 and April 2018 at an academic tertiary institution were considered for inclusion in this longitudinal cohort study. Patient-reported outcomes were collected at baseline and ≥1 year after surgery. Univariate and multivariable linear regression analyses were performed to identify factors associated with the magnitude of functional improvement on the QuickDASH and UE CAT. RESULTS Among 93 included participants, the mean age was 61 ± 7 years, and 75 (81%) were women. At 2.5 ± 1.0 years after surgery, the QuickDASH and UE CAT improved by a mean of 24.5 ± 20.9 and 9.9 ± 10.7 points, respectively. In the primary multivariable model, a greater preoperative QuickDASH (indicative of lower function; coefficient, 0.8; 95% confidence interval [CI], 0.6 to 0.9) and lower preoperative Performance of Patient-Reported Outcomes Measurement Information System PI CAT (eg, less pain interference; coefficient, -0.7; 95% CI, -1.2 to -0.2) were associated with greater QuickDASH improvement independent of potential confounders. In the secondary multivariable model, lower preoperative UE CAT (indicative of worse function; coefficient, -0.9; 95% CI, -1.1 to -0.7) and lower preoperative Patient-Reported Outcomes Measurement Information System PI CAT (coefficient, -0.3; 95% CI, -0.6 to -0.1) were associated with greater UE CAT improvement. CONCLUSIONS Preoperative patient-reported outcomes may be useful in understanding the degree of improvement that certain patient populations can expect from ligament reconstruction tendon interposition. Those with lower baseline (preoperative) upper-extremity function and PI are expected to derive the greatest functional improvement in the midterm. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.
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Affiliation(s)
- Jordan W Clawson
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT
| | - Miranda J Rogers
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT
| | - Christopher Stockburger
- Hand & Upper Extremity Department, Orthopaedic & Spine Center of the Rockies, Fort Collins, CO
| | - Zhining Ou
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT
| | - Angela P Presson
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT
| | - Nikolas H Kazmers
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT.
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Use of Hand Therapy After Distal Radius Fracture: A National Perspective. J Hand Surg Am 2022; 47:1117.e1-1117.e9. [PMID: 34666936 DOI: 10.1016/j.jhsa.2021.08.018] [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] [Received: 03/06/2020] [Revised: 06/29/2021] [Accepted: 08/25/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess whether certain distal radius fracture (DRF) patients, such as opioid users or complex regional pain syndrome (CRPS) patients, receive more hand therapy. METHODS Using the IBM MarketScan Research Databases from January 1, 2012, to December 31, 2016, we identified a cohort of DRF patients and created 4 subgroups of interest: frequent follow-up patients, persistent opioid users, prior opioid users, and patients with CRPS. We measured rates and demographic characteristics associated with therapy use in our populations of interest. RESULTS In this cohort of 87,313 patients, 21% received hand therapy after primary DRF treatment. Patients with CRPS had a higher rate of therapy than non-CRPS patients (44% vs 21%, respectively). Frequent follow-up patients used more therapy than those with less follow-up (30% vs 17%, respectively). Persistent opioid users demonstrated slightly increased therapy use compared to the remaining population (25% vs 22%, respectively). Prior opioid users underwent less therapy than patients without prior opioid use (19% vs 22%, respectively). Female sex, residing in the Northeast, being on a preferred provider organization plan, and having more intense surgical treatments were associated with increased therapy use. CONCLUSIONS This study showed variations in therapy use after DRF in subpopulations of interest. Patients with CRPS, persistent opioid use, and frequent follow-ups had higher rates of therapy. Patients with prior opioid use had lower rates of therapy. CLINICAL RELEVANCE Therapy is more common in patients with DRF with CRPS, persistent opioid use, or more follow-up visits.
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Meta F, Khalil LS, Ziedas AC, Gulledge CM, Muh SJ, Moutzouros V, Makhni EC. Preoperative Opioid Use Is Associated With Inferior Patient-Reported Outcomes Measurement Information System Scores Following Rotator Cuff Repair. Arthroscopy 2022; 38:2787-2797. [PMID: 35398483 DOI: 10.1016/j.arthro.2022.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 03/20/2022] [Accepted: 03/22/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the influence of preoperative opioid use on Patient-Reported Outcomes Measurement Information System (PROMIS) scores pre- and postoperatively in patients undergoing arthroscopic rotator cuff repair (RCR). METHODS A retrospective review of all RCR patients aged >18 years old was performed. PROMIS pain interference ("PROMIS PI"), upper extremity function ("PROMIS UE"), and depression ("PROMIS D") scores, were reviewed. These measures were collected at preoperative, 6-month, and 1-year postoperative time points. A prescription drug-monitoring program was queried to track opioid prescriptions. Patients were categorized as chronic users, acute users, and nonusers based on prescriptions filled. Comparison of means were carried out using analysis of variance and least squares means. Effect sizes and 95% confidence intervals were calculated. RESULTS In total, 184 patients who underwent RCR were included. Preoperatively, nonusers (n = 92) had superior PROMIS UE (30.6 vs 28.9 vs 26.1; P < .05) and PI scores (61.5 vs 64.9 vs 65.3; P < .001) compared with acute users (n = 65) and chronic users (n = 27), respectively. At 6 months postoperatively; nonusers demonstrated significantly greater PROMIS UE (41.7 vs 35.6 vs. 33.5; P < .001), lower PROMIS D (41.6 vs 45.8 vs 51.1; P < .001), and lower PROMIS PI scores (50.7 vs 56.3 vs 58.1; P < .01) when compared with acute and chronic users, respectively. Nonusers had lower PROMIS PI (47.9 vs 54.3 vs 57.4; P < .0001) and PROMIS D (41.6 vs 48.3 vs 49.2; P = .0002) scores compared with acute and chronic users at 1-year postoperatively. Nonusers experienced a significantly greater magnitude of improvement in PROMIS D 6 months postoperatively compared with chronic opioid users (-5.9 vs 0.0; P < .01). CONCLUSIONS Patients undergoing RCR demonstrated superior PROMIS scores pre- and postoperatively if they did not use opioids within 3 months before surgery. LEVEL OF EVIDENCE III, retrospective comparative trial.
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Affiliation(s)
- Fabien Meta
- Department of Orthopedic Surgery, Henry Ford Hospital, Detroit, Michigan, U.S.A..
| | - Lafi S Khalil
- Department of Orthopedic Surgery, Henry Ford Hospital, Detroit, Michigan, U.S.A
| | | | - Caleb M Gulledge
- Wayne State University School of Medicine, Detroit, Michigan, U.S.A
| | - Stephanie J Muh
- Department of Orthopedic Surgery, Henry Ford Hospital, Detroit, Michigan, U.S.A
| | - Vasilios Moutzouros
- Department of Orthopedic Surgery, Henry Ford Hospital, Detroit, Michigan, U.S.A
| | - Eric C Makhni
- Department of Orthopedic Surgery, Henry Ford Hospital, Detroit, Michigan, U.S.A
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Larger Perioperative Opioid Prescriptions Lead to Prolonged Opioid Use After Hand and Upper Extremity Surgery: A Multicenter Analysis. J Am Acad Orthop Surg Glob Res Rev 2022; 6:01979360-202210000-00009. [PMID: 36734644 PMCID: PMC9592474 DOI: 10.5435/jaaosglobal-d-22-00036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 07/20/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION The opioid epidemic remains an ongoing public health crisis. The purpose of this study was to investigate whether surgeons' prescribing patterns of the initial postoperative opioid prescription predispose patients to prolonged opioid use after upper extremity surgery. METHODS This multicenter retrospective study was done at three academic institutions. Patients who underwent carpal tunnel release, basal joint arthroplasty, and distal radius fracture open reduction and internal fixation over a 1.5-year period were included. Opioid prescription data were obtained from the Pennsylvania Prescription Drug Monitoring Program website. RESULTS Postoperatively, 30.1% of the patients (191/634) filled ≥1 additional opioid prescription, and 14.0% (89/634) experienced prolonged opioid use 3 to 6 months postoperatively. Patients who filled an additional prescription postoperatively were initially prescribed significantly more pills (P = 0.001), a significantly longer duration prescription (P = 0.009), and a significantly larger prescription in total milligram morphine equivalents (P = 0.002) than patients who did not fill additional prescriptions. Patients who had prolonged opioid use were prescribed a significantly longer duration prescription (P = 0.026) than those without prolonged use. CONCLUSION Larger and longer duration of initial opioid prescriptions predisposed patients to continued postoperative opioid use. These findings emphasize the importance of safe and evidence-based prescribing practices to prevent the detrimental effects of opioid use after orthopaedic surgery.
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Aneizi A, Gelmann D, Ventimiglia DJ, Sajak PMJ, Nadarajah V, Foster MJ, Weir TB, Akabudike NM, Pensy RA, Henn RF. Preoperative Opioid Use in Patients Undergoing Common Hand Surgeries. Hand (N Y) 2022; 17:905-912. [PMID: 33467941 PMCID: PMC9465804 DOI: 10.1177/1558944720974122] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND The objectives of this study were to determine the baseline patient characteristics associated with preoperative opioid use and to establish whether preoperative opioid use is associated with baseline patient-reported outcome measures in patients undergoing common hand surgeries. METHODS Patients undergoing common hand surgeries from 2015 to 2018 were retrospectively reviewed from a prospective orthopedic registry at a single academic institution. Medical records were reviewed to determine whether patients were opioid users versus nonusers. On enrollment in the registry, patients completed 6 Patient-Reported Outcomes Measurement Information System (PROMIS) domains (Physical Function, Pain Interference, Fatigue, Social Satisfaction, Anxiety, and Depression), the Brief Michigan Hand Questionnaire (BMHQ), a surgical expectations questionnaire, and Numeric Pain Scale (NPS). Statistical analysis included multivariable regression to determine whether preoperative opioid use was associated with patient characteristics and preoperative scores on patient-reported outcome measures. RESULTS After controlling for covariates, an analysis of 353 patients (opioid users, n = 122; nonusers, n = 231) showed that preoperative opioid use was associated with higher American Society of Anesthesiologists class (odds ratio [OR], 2.88), current smoking (OR, 1.91), and lower body mass index (OR, 0.95). Preoperative opioid use was also associated with significantly worse baseline PROMIS scores across 6 domains, lower BMHQ scores, and NPS hand scores. CONCLUSIONS Preoperative opioid use is common in hand surgery patients with a rate of 35%. Preoperative opioid use is associated with multiple baseline patient characteristics and is predictive of worse baseline scores on patient-reported outcome measures. Future studies should determine whether such associations persist in the postoperative setting between opioid users and nonusers.
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Affiliation(s)
- Ali Aneizi
- University of Maryland School of
Medicine, Baltimore, USA
| | | | | | | | | | | | | | | | | | - R. Frank Henn
- University of Maryland School of
Medicine, Baltimore, USA
- University of Maryland School of
Medicine and University of Maryland Rehabilitation & Orthopaedic Institute,
Baltimore, USA
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Self-reported cannabis use is not associated with greater opioid use in elective hand surgery patients. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY 2022:10.1007/s00590-022-03321-z. [PMID: 35986814 PMCID: PMC9392061 DOI: 10.1007/s00590-022-03321-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 06/15/2022] [Indexed: 10/26/2022]
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Evaluation of Factors Affecting Return to Work Following Carpal Tunnel Release: A Statewide Cohort Study of Workers' Compensation Subjects. J Hand Surg Am 2022; 47:544-553. [PMID: 35484044 DOI: 10.1016/j.jhsa.2022.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 01/07/2022] [Accepted: 02/16/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE Most randomized trials comparing open carpal tunnel release (OCTR) to endoscopic carpal tunnel release (ECTR) are not specific to a working population and focus mainly on how surgical technique has an impact on outcomes. This study's primary goal was to evaluate factors affecting days out of work (DOOW) following carpal tunnel release (CTR) in a working population and to evaluate for differences in medical costs, indemnity payments, disability ratings, and opioid use between OCTR and ECTR with the intent of determining whether one or the other surgical method was a determining factor. METHODS Using the Ohio Bureau of Workers' Compensation claims database, individuals were identified who underwent unilateral isolated CTR between 1993 and 2018. We excluded those who were on total disability, who underwent additional surgery within 6 months of their index CTR, including contralateral or revision CTR, and those not working during the same month as their index CTR. Outcomes were evaluated at 6 months after surgery. Multivariable linear regression was performed to evaluate covariates associated with DOOW. RESULTS Of the 4596 included participants, 569 (12.4%) and 4027 (87.6%) underwent ECTR and OCTR, respectively. Mean DOOW were 58.4 for participants undergoing OCTR and 56.6 for those undergoing ECTR. Carpal tunnel release technique was not predictive of DOOW. Net medical costs were 20.7% higher for those undergoing ECTR. Multivariable linear regression demonstrated the following significant predictors of higher DOOW: preoperative opioid use, legal representation, labor-intensive occupation, increasing lag time from injury to filing of a worker's compensation claim, and female sex. Being married, higher income community, and working in the public sector were associated with fewer DOOW. CONCLUSIONS In a large statewide worker's compensation population, demographic, occupational, psychosocial, and litigatory factors have a significant impact on DOOW following CTR, whereas differences in surgical technique between ECTR and OCTR did not. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic III.
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Okoli MU, Rondon AJ, Townsend CB, Sherman MB, Ilyas AM. Comprehensive Analysis of Opioid Use After Common Elective Outpatient Orthopaedic Surgeries. J Am Acad Orthop Surg Glob Res Rev 2022; 6:01979360-202204000-00014. [PMID: 35412506 PMCID: PMC10566975 DOI: 10.5435/jaaosglobal-d-21-00226] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 01/28/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Prescription opioid abuse remains an ongoing public health crisis, especially in orthopaedic surgery. The purpose of the present study is to analyze opioid-prescribing patterns and investigate risk factors for prolonged opioid use after common outpatient orthopaedic surgical procedures. METHODS After institutional review board approval, a review of 1,384 patients undergoing common elective outpatient orthopaedic procedures from January 2018 to June 2019 was conducted. Data on controlled substance prescriptions were obtained from the prescription drug monitoring program website. Statistical analysis was done to identify predictors for a second opioid prescription and prolonged opioid use (>6 months). RESULTS Over 10% (150/1,384) of patients were still using opioids beyond 6 months. Of the opioid exposed patients, 60.4% (174/288) filled at least 1 additional opioid prescription postoperatively, and 29.2% (84/288) filled prescriptions beyond 6 months, compared with 26.4% (289/1,096) and 6.0% (66/1,096) of opioid-naive patients, respectively. Following multivariate analysis, significant predictors for filling a second opioid prescription included preoperative opioid use, current smoker status, benzodiazepine use, psychiatric disorder, and advanced age. CONCLUSION This study revealed risk factors for prolonged opioid use after orthopaedic surgery. Surgeons should be mindful of these risk factors and counsel patients regarding postoperative pain management.
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Affiliation(s)
- Michael U. Okoli
- From the Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA (Dr. Okoli, Dr. Rondon, Dr. Townsend, Dr. Sherman, and Dr. Ilyas), and the Rothman Opioid Foundation, Philadelphia, PA (Dr. Ilyas)
| | - Alexander J. Rondon
- From the Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA (Dr. Okoli, Dr. Rondon, Dr. Townsend, Dr. Sherman, and Dr. Ilyas), and the Rothman Opioid Foundation, Philadelphia, PA (Dr. Ilyas)
| | - Clay B. Townsend
- From the Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA (Dr. Okoli, Dr. Rondon, Dr. Townsend, Dr. Sherman, and Dr. Ilyas), and the Rothman Opioid Foundation, Philadelphia, PA (Dr. Ilyas)
| | - Matthew B. Sherman
- From the Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA (Dr. Okoli, Dr. Rondon, Dr. Townsend, Dr. Sherman, and Dr. Ilyas), and the Rothman Opioid Foundation, Philadelphia, PA (Dr. Ilyas)
| | - Asif M. Ilyas
- From the Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA (Dr. Okoli, Dr. Rondon, Dr. Townsend, Dr. Sherman, and Dr. Ilyas), and the Rothman Opioid Foundation, Philadelphia, PA (Dr. Ilyas)
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Zeiderman MR, Pereira CT. Substance Addiction and the Hand Surgery Patient: A Comprehensive Review. J Hand Surg Am 2021; 46:790-799. [PMID: 34247846 DOI: 10.1016/j.jhsa.2021.05.016] [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] [Received: 06/14/2020] [Revised: 01/06/2021] [Accepted: 05/06/2021] [Indexed: 02/02/2023]
Abstract
Substance abuse is pervasive in the American society, with 10% of the United States population using marijuana, up to 17% of patients undergoing upper-extremity surgery reporting chronic opioid use, and up to 20% of acute hand infections occurring secondary to intravenous drug use. It is common, therefore, for a hand surgeon to take care of a patient under the influence of nonprescription drugs. The range of abused substances is diverse, and the implications are profound. As such, it is important for hand surgeons to understand the potential implications of drug use to best guide patient care and surgical decision-making. The abuse of opioids, amphetamines, marijuana, and other substances has an impact on treatment timing, adherence to postoperative hand therapy, and/or clinic follow ups. The physiologic effects of these drugs affect surgical risk, wound healing, and bone healing. Social factors associated with drug abuse can complicate the management of these patients. Collectively, all these factors substantially affect surgical outcomes. In this review, we provide an overview of commonly abused illicit and prescription drugs seen in hand surgery practice, tips to identify substance abuse, the drugs' implications for surgical risks, outcomes, and some recommendations for management.
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Affiliation(s)
- Matthew R Zeiderman
- Department of Surgery, Division of Plastic & Reconstructive Surgery, University of California, Davis, Sacramento, CA
| | - Clifford T Pereira
- Department of Surgery, Division of Plastic & Reconstructive Surgery, University of California, Davis, Sacramento, CA.
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Abstract
BACKGROUND Currently, opioids are the standard of care for postoperative pain management. Avoiding unnecessary opioid exposure in patients is of current interest because of widespread abuse. METHODS This is a prospective cohort study in which wide-awake, local anesthesia, no-tourniquet (WALANT) technique was used for 94 hand/upper extremity surgical patients and compared to patient cohorts undergoing similar procedures under monitored anesthesia care. Patients were not prescribed opioids postoperatively but were instead directed to use over-the-counter pain relievers. Pain scores on a visual analogue scale were collected from patients preoperatively, and on postoperative days 1 and 14. WALANT visual analogue scale scores were compared to those of the two patient cohorts who either did or did not receive postoperative opioids after undergoing similar procedures under monitored anesthesia care. Electronic medical records and New York State's prescription monitoring program, Internet System for Tracking Over-Prescribing, were used to assess prescription opioid-seeking. Information on sex, age, comorbidity burden, previous opioid exposure, and insurance coverage was also collected. RESULTS Decreased pain was reported by WALANT patients 14 days postoperatively compared to preoperatively and 1 day postoperatively, with a total group mean pain score of 0.37. This is lower than mean scores of monitored anesthesia care patients with and without postoperative opioids. Only two WALANT patients (2.1 percent) sought opioid prescriptions from outside providers. There was little evidence suggesting factors including sex, age, comorbidity burden, previous opioid exposure, or insurance status alter these results. CONCLUSION WALANT may be a beneficial technique hand surgeons may adopt to mitigate use of postoperative opioids and reduce risk of abuse in patients. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, II.
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Forlenza EM, Lu Y, Cohn MR, Baker J, Lavoie-Gagne O, Yanke AB, Cole BJ, Verma NN, Forsythe B. Establishing Clinically Significant Outcomes for Patient-Reported Outcomes Measurement Information System After Biceps Tenodesis. Arthroscopy 2021; 37:1731-1739. [PMID: 33450409 DOI: 10.1016/j.arthro.2020.12.236] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 12/28/2020] [Accepted: 12/29/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To establish thresholds for improvement in patient-reported outcome scores that correspond with clinically significant outcomes (CSOs) including the minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) for Patient-Reported Outcomes Measurement Information System (PROMIS) upper extremity (UE) computer adaptive testing (CAT) and pain interference (PIF) CAT after biceps tenodesis (BT) and to assess patient variables that are associated with achieving these outcomes. METHODS After institutional review board approval was obtained, a prospectively maintained institutional database was queried for patients undergoing BT between December 2017 and August 2019. Patients undergoing BT in isolation or BT in conjunction with rotator cuff debridement, SLAP repair, subacromial decompression, or distal clavicle excision were included in the analysis. Anchor- and distribution-based methods were used to calculate the MCID whereas an anchor-based method was used to calculate SCB and the PASS for PROMIS UE CAT and PIF CAT. RESULTS A total of 112 patients (86.8% follow-up) who underwent BT were included for analysis. The MCID, net SCB, absolute SCB, and PASS for PROMIS UE CAT were 4.02, 9.25, 43.4, and 41.1, respectively. The MCID, net SCB, absolute SCB, and PASS for PROMIS PIF CAT were -4.12, -10.7, 52.4, and 52.4, respectively. Higher preoperative UE CAT and PIF CAT scores, preoperative opioid use, depression, and living alone were negative predictors of CSO achievement. Male sex and regular participation in exercise were positive predictors of CSO achievement. CONCLUSIONS Patients with higher preoperative UE scores were less likely to achieve the MCID (odds ratio [OR], 0.84), whereas patients with higher preoperative PIF scores were less likely to achieve absolute SCB and the PASS (OR, 0.83-0.89). Most patients achieved the MCID for PIF CAT (70.5%) and UE CAT (62.5%) at final follow-up. Male sex (OR, 4.38-9.15) and regular exercise participation (OR, 6.45-18.94) positively predicted CSO achievement, whereas preoperative opioid use (OR, 0.06), depression (OR, 0.23), and living alone (OR, 0.90) were negative predictors of CSO achievement. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
| | - Yining Lu
- Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Matthew R Cohn
- Rush University Medical Center, Chicago, Illinois, U.S.A
| | - James Baker
- Rush University Medical Center, Chicago, Illinois, U.S.A
| | | | - Adam B Yanke
- Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Brian J Cole
- Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Nikhil N Verma
- Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Brian Forsythe
- Rush University Medical Center, Chicago, Illinois, U.S.A..
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