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Khalil LS, Jildeh TR, Ussef N, Rahman T, Carter E, Pawloski M, Tandron M, Moutzouros V. Extensor Mechanism Ruptures and Reruptures: Perioperative Opioid Management. J Knee Surg 2022; 35:167-175. [PMID: 32643781 DOI: 10.1055/s-0040-1713777] [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] [Indexed: 02/07/2023]
Abstract
The purpose of this study was to determine (1) the correlation between preoperative and postoperative opioid use and (2) risk factors associated with rerupture in patients undergoing open extensor mechanism repair. A retrospective review of patients who underwent operative repair of quadriceps or patellar tendon rupture was performed. Patients were classified as opioid nonusers if they had not received any opioid medications in the 3 months before surgery, or as acute users or chronic users if they received at least one opioid prescription within 1 month or 3 months preceding surgery. Clinical records were reviewed for postoperative opioid use within a year after surgery as well as rerupture rates. A total of 144 quadriceps tendon and 15 patellar tendon repairs were performed at a mean age of 56.8 ± 15.1 years and body mass index of 33.2 ± 7.1. The overall rerupture rate was 6%. Diabetes was a significant risk factor for rerupture (56 vs. 19%, p = 0.023). Chronic preoperative opioid users were more likely to continue to use opioids beyond 1 month postoperatively (p < 0.001) as compared with acute or nonopioid users. Chronic preoperative opioid users (relative risk [RR]: 3.53, 95% confidence interval [CI]: 2.11-5.90) and patients with longer anesthesia time (RR: 1.39, 95% CI: 1.00-1.93) required more monthly opioid refills, whereas tourniquet use required fewer opioid refills each month (RR: 0.57, 95% CI: 0.37-0.88). Compared with patients without a rerupture, each additional prescription refill after the initial repair in the rerupture group was associated with a 22% higher risk of tendon rerupture (RR: 1.22, 95% CI: 1.07-1.39). The chronicity of preoperative opioid intake was found to have a significant effect on postoperative opioid use. This study suggests that there is a higher prevalence of rerupture in patients with prolonged opioid use postoperatively and among diabetics.
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Affiliation(s)
- Lafi S Khalil
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan
| | - Toufic R Jildeh
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan
| | - Najib Ussef
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan
| | - Tahsin Rahman
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan
| | - Erika Carter
- School of Medicine, Wayne State University School of Medicine, Detroit, Michigan
| | - Megan Pawloski
- School of Medicine, Wayne State University School of Medicine, Detroit, Michigan
| | - Marissa Tandron
- School of Medicine, Wayne State University School of Medicine, Detroit, Michigan
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Kim J, Waitzman N, Richards N, Adams T. Prescriptions for pain medication before and after bariatric surgery. Surg Endosc 2021; 36:4960-4968. [PMID: 34734303 DOI: 10.1007/s00464-021-08852-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 10/21/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Significant and sustained weight loss resulting from bariatric surgery have demonstrated clinical reduction in severe obesity-related pain. Subsequentially, post-surgical pain reduction may reduce pain medication use. However, clear evidence regarding use of prescribed pain medications before and after bariatric surgery is absent. METHODS Linking two state-wide databases, patients who underwent bariatric surgery between July 1, 2013 and December 31, 2015 were identified. Proportion tests were used to compare percent of patients with pain medication prescriptions 1 year before and 1 year after bariatric surgery. Logistic regression was used to identify baseline factors that were associated with pain medication use 1-year following surgery. RESULTS A total of 3535 bariatric surgical patients aged 18-64 years at surgery were identified. Of these patients, 1339 patients met the following study criteria: covered by private insurance; known pre-surgical BMI; and continuous enrollment with health plan(s) from 12-month pre-surgery to 13-month post-surgery. While comparison of average number of overall pain medication prescriptions before and after surgery did not change, from 3.46 to 3.32 prescriptions (p value = 0.26), opioid prescription use increased from 1.62 vs. 2.05 (p value < 0.01). Patients prescribed more types of pain medications before surgery were more likely to have prescribed pain medications after surgery. Patients prescribed benzodiazepines at baseline had higher odds being prescribed post-surgery corticosteroids (OR = 1.89, p value < 0.01), muscle relaxants (OR = 2.18, p value < 0.01), and opioids (OR = 3.06, p value = < 0.01) compared to patients without pre-surgery--prescribed benzodiazepine. CONCLUSION While comparison of average number of overall pain medication prescriptions before and after bariatric surgery did not decrease, opioid prescription increased post-surgery. Further studies are needed to examine whether post-surgery opioids are prescribed in lieu of or in tandem with other pain medication prescriptions.
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Affiliation(s)
- Jaewhan Kim
- Department of Physical Therapy, University of Utah, 520 Wakara Way, Salt Lake City, UT, 84108, USA.
| | - Norman Waitzman
- Department of Economics, University of Utah, 260 Central Campus Dr #4100, Salt Lake City, UT, 84112, USA
| | - Nathan Richards
- Intermountain Health Care, 5300 South State Street, Murray, UT, 84107, USA
| | - Ted Adams
- Division of Epidemiology, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84108, USA
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Monahan PF, Jimenez AE, Owens JS, Saks BR, Maldonado DR, Ankem HK, Sabetian PW, Lall AC, Domb BG. Revision Hip Arthroscopy in High-Level Athletes: Minimum 2-Year Outcomes Comparison to a Propensity-Matched Primary Hip Arthroscopy Control Group. Am J Sports Med 2021; 49:3582-3591. [PMID: 34591692 DOI: 10.1177/03635465211041760] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Outcomes of revision hip arthroscopy in the athletic population have not been well established. PURPOSE (1) To report clinical outcomes for high-level athletes undergoing revision hip arthroscopy in the setting of femoroacetabular impingement syndrome (FAIS) or labral tears and (2) to compare these outcomes against a propensity-matched group of high-level athletes undergoing primary hip arthroscopy. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Data for professional, college, and high school athletes were prospectively collected and retrospectively reviewed between January 2012 and October 2018. Patients were included if they underwent revision or primary hip arthroscopy and had preoperative and minimum 2-year patient-reported outcome (PRO) scores for modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score Sports-Specific Subscale (HOS-SSS), and visual analog scale (VAS) for pain. The findings and outcomes of revision athletes were compared with a propensity-matched control group of high-level athletes undergoing primary hip arthroscopy. RESULTS A total of 32 hips (29 patients) undergoing revision hip arthroscopy and 92 hips (88 patients) undergoing primary hip arthroscopy were included in our final analysis with a median follow-up time of 29.5 months (95% CI, 27.2-32.1 months) and 36.5 months (95% CI, 33.5-37.7 months), respectively. Athletes undergoing revision surgery showed significant improvement in all recorded PRO measurements and achieved patient acceptable symptomatic state (PASS) and minimal clinically important difference (MCID) for mHHS at high rates (80.6% and 83.9%, respectively). When compared with a propensity-matched primary control group, patients undergoing revision surgery demonstrated lower preoperative and postoperative scores for mHHS, NAHS, and HOS-SSS, but the magnitude of improvement in functional scores was similar between groups. Athletes undergoing revision surgery achieved PASS for HOS-SSS at lower rates than the control group (P = .005), and they were less likely to attempt to return to sport compared with the control group (62.5% vs 87.0%; P < .01). CONCLUSION Revision hip arthroscopy is a viable treatment option to improve PROs in high-level athletes at minimum 2-year follow-up. The study group showed significant improvement in functional scores and a high rate of successful outcomes. They experienced similar magnitude of improvement as that of a propensity-matched control group; however, they achieved lower postoperative PRO scores and attempted to return to sport at lower rates.
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Affiliation(s)
- Peter F Monahan
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Andrew E Jimenez
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Jade S Owens
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Benjamin R Saks
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,AMITA Health St Alexius Medical Center, Hoffman Estates, Illinois, USA
| | | | - Hari K Ankem
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Payam W Sabetian
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Ajay C Lall
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,AMITA Health St Alexius Medical Center, Hoffman Estates, Illinois, USA.,American Hip Institute, Chicago, Illinois, USA
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,AMITA Health St Alexius Medical Center, Hoffman Estates, Illinois, USA.,American Hip Institute, Chicago, Illinois, USA
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Clinical outcomes after revision hip arthroscopy in patients with femoroacetabular impingement syndrome (FAIS) are inferior compared to primary procedures. Results from the Danish Hip Arthroscopy Registry (DHAR). Knee Surg Sports Traumatol Arthrosc 2021; 29:1340-1348. [PMID: 32653932 DOI: 10.1007/s00167-020-06135-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 06/26/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE As many as 10% of primary hip arthroscopies end up with a revision arthroscopy procedure when treating patients suffering from femoroacetabular impingement syndrome (FAIS). In general, revision procedures are indicated because of residual impingement, but only a few studies present outcome data from revision hip arthroscopy after failed FAIS surgical treatment. The purpose of this study was to evaluate clinical outcomes after revision hip arthroscopy in a FAIS cohort and compare outcomes with a primary FAIS hip arthroscopy cohort and describe potential causes of failure after the primary hip arthroscopy. It was hypothesized that subjective outcomes improve after revision hip arthroscopy although outcomes were expected to be inferior to primary hip arthroscopic outcomes. METHODS Three-hundred and thirty-one arthroscopic revision hip FAIS patients were included from the Danish Hip Arthroscopy Registry (DHAR). Patient-related outcome measures (PROM's), Copenhagen Hip and Groin Outcome Scores (HAGOS), Hip Sports Activity Scale (HSAS), EQ-5D and Numeric Rating Scale (NRS) pain, were assessed in the study cohort prior to the primary procedure and at revision and at follow-up one year after the revision procedure. These data were compared with 4154 primary hip arthroscopic FAIS patients. RESULTS One-year after revision surgery, mean follow-up (in months ± SD): 12.3 ± 1.6, significant improvements (p < 0.05) in all PROMs was demonstrated, but FAIS patients in the primary hip arthroscopic cohort demonstrated significantly higher outcomes, in all PROMs, when compared at one-year follow-up. Scar tissue, residual osseous impingement and insufficient healing of the labral repair were reported as the main reasons for revision surgery. The conversion to total hip arthroplasty was low (6.4%). CONCLUSION Revision hip arthroscopy in FAIS patients improves subjective outcomes significantly, although they are poorer than after primary FAIS hip arthroscopy. Main reasons for revision arthroscopy was scar tissue, residual femoroacetabular impingement and insufficient healing of labral repair. LEVEL OF EVIDENCE Level III.
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Effects of Post-operative Nutritional Disorders Following Bariatric Surgery on Health Care Cost and Use. Obes Surg 2021; 31:2503-2510. [PMID: 33625656 DOI: 10.1007/s11695-021-05279-z] [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: 01/14/2021] [Revised: 02/09/2021] [Accepted: 02/09/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Risk of nutritional disorders (NDs) in bariatric surgical patients has led to guideline recommendations for pre- and post-operative nutrient deficiency screening. The aim of this study was to identify baseline factors associated with incident NDs and, in addition, to explore possible differences in health care spending and use between patients with and without incident NDs following bariatric surgery. MATERIALS AND METHODS Using data linked with a state-wide bariatric surgical registry and a state-wide claims database, subjects who underwent bariatric surgery between July 1, 2013, and December 31, 2015, were identified. Incident NDs and health care cost and use outcomes following 1 year from surgery were extracted from the claims data. Logistic regression was used to identify baseline factors associated with incident NDs. Zero-inflated negative binomial regression and generalized linear regression were used to estimate health care cost and use outcomes. RESULTS A total of 3535 patients who underwent bariatric surgery were identified. Of these patients, those without continuous health insurance enrollment (n=1880), having prevalent (pre-surgery) NDs (n=461), and missing baseline BMI (n=41) were excluded. Of patients analyzed (n=1153), about 30% had incident NDs, with a mean (SD) age and BMI at surgery of 46 (12) years and 48 (9.2) kg/m2, respectively. Patients with one incident ND had higher total health care spending (coefficient=$41118, p-value<0.01) and ED visits (IRR=1.86, p-value<0.01). CONCLUSION Those without pre-operative NDs may have a higher chance of having NDs post-operatively. Taking multivitamins and continues monitoring are necessary to prevent any negative outcomes related to post-operative NDs.
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Vesey RM, Bacon CJ, Brick MJ. Pre-existing osteoarthritis remains a key feature of arthroscopy patients who convert to total hip arthroplasty. J ISAKOS 2020; 6:199-203. [PMID: 34272295 DOI: 10.1136/jisakos-2020-000492] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To determine the rate of conversion to total hip arthroplasty following ipsilateral hip arthroscopy by a single surgeon in New Zealand and to describe patient-related and surgical characteristics of patients who converted. METHODS A retrospective cohort analysis of hip arthroscopy patients with 2 years of minimum follow-up identified the total hip arthroplasty conversion rate using the New Zealand National Joint Registry. Prospective data collected from patients who subsequently converted to hip arthroplasty included: sex, age at arthroscopy, body mass index, side of hip arthroscopy and arthroplasty, duration of symptoms and patient-reported outcome measures. Imaging (Tönnis grade and lateral centre-edge angle) and surgical findings (labral, ligamentum teres and osteochondral pathology) along with the arthroscopic procedures performed were also documented. RESULTS Sixty-six out of 1856 (3.56%) primary hip arthroscopies were followed by an ipsilateral hip arthroplasty during the follow-up period (mean 87 ± 29 months). Most patients had pre-existing osteoarthritis and/or chondral lesions (n=51). Dysplasia and over-resection of the acetabulum were also identified as contributing factors. CONCLUSION Conversion rate by a high-volume surgeon in New Zealand was relatively low. Most patients had pre-existing osteoarthritis and/or chondral lesions that became apparent at arthroscopy. Dysplasia is also a factor to be cautious of when selecting patients for arthroscopy. Acetabular resection must be approached cautiously. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Renuka M Vesey
- Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand .,Orthosports North Harbour Ltd., Millennium Institute of Sport and Health, Auckland, New Zealand
| | - Catherine J Bacon
- Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.,Orthosports North Harbour Ltd., Millennium Institute of Sport and Health, Auckland, New Zealand
| | - Matthew J Brick
- Orthosports North Harbour Ltd., Millennium Institute of Sport and Health, Auckland, New Zealand
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Kim J, Simper S, McKinlay R, Cottam D, Surve A, Adams T. Healthcare cost and utilization of bariatric surgical patients with and without preoperative mental health diagnoses. Surg Obes Relat Dis 2020; 16:682-689. [PMID: 32178984 DOI: 10.1016/j.soard.2020.01.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 01/22/2020] [Accepted: 01/31/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Postoperative healthcare cost and use among patients with and without preoperative mental health illness are not well known. OBJECTIVE This study compared total healthcare spending and use (emergency department [ED] visits and inpatient admissions) after 1 year post operation of those with and without preoperative mental health disorders. SETTING United States. METHODS Mental illness disorders were identified using International Classification of Disease-9/10 diagnosis codes in a statewide bariatric surgery registry and in claims databases that were linked to identify the study cohort. Generalized linear regression and zero-inflated negative binomial regression were used for the healthcare cost and use outcomes. RESULTS Among 3580 registry patients with private insurance, 1610 patients with continuous enrollment and without missing body mass index data were included. Among patients, 56.8% (n = 915) had diagnosed mental health disorders before surgery. Those with mental illness spent more in total cost than those without mental illness (unstandardized coefficient = $18,513, P value < .01) in the first year after surgery. Those with mental illness had a 73% higher rate in ED visits (P value < .01), 83% higher rate in preventable ED use (P value < .01), and a 101% higher rate in hospital admissions (P value < .01) than those without mental illness. CONCLUSIONS Patients with mental health diagnoses before having bariatric surgery appear to have significant positive association with surgical outcomes relating to postsurgical healthcare cost and utilization. Greater postsurgical surveillance may be warranted for bariatric surgery patients with preoperative mental illness to reduce postoperative ED visits and inpatient admissions.
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Affiliation(s)
- Jaewhan Kim
- Department of Physical Therapy, University of Utah, Salt Lake City, Utah.
| | | | | | | | - Amit Surve
- Bariatric Medicine Institute, Salt Lake City, Utah
| | - Ted Adams
- Live Well Center, Intermountain Healthcare, Salt Lake City, Utah
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