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Brian R, Lancaster E, Hiramoto J. A "just in time" educational intervention for opioid overprescribing in dialysis access surgery. Am J Surg 2024:S0002-9610(24)00193-4. [PMID: 38575443 DOI: 10.1016/j.amjsurg.2024.03.024] [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: 12/02/2023] [Revised: 03/04/2024] [Accepted: 03/27/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Despite widespread efforts to combat the opioid epidemic, an ongoing contributor to opioid misuse remains post-operative opioid overprescribing by residents. The goal of this study was to evaluate the impact of a low-cost, reproducible "just in time" intervention on opioid prescribing in dialysis access operations. METHODS Standardized opioid prescribing guidelines were emailed to residents on the vascular service on the first day of the rotation. Opioid prescriptions were reviewed for four years before and one year after this intervention. Wilcoxon rank-sum test and tests of proportions were used to compare groups. RESULTS Overall, 299 patients underwent dialysis access procedures. There was a decrease in patients discharged with opioids following the intervention from 58% to 36% (p = 0.003). For patients prescribed opioids, the median quantity decreased from 90 to 45 oral morphine equivalents (p = 0.03). CONCLUSIONS This low-cost and timely learning intervention may be a useful adjunct to reduce post-operative opioid prescriptions.
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Affiliation(s)
- Riley Brian
- Department of Surgery, University of California, San Francisco, USA.
| | | | - Jade Hiramoto
- Department of Surgery, University of California, San Francisco, USA
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Chambers MM, Castaneda DM, Rivera-Pintado C, Gentile P, Hunter K, Fedorka CJ. Mental health disorders and pain modulation in orthopedic shoulder patients. JSES Int 2023; 7:2523-2527. [PMID: 37969524 PMCID: PMC10638564 DOI: 10.1016/j.jseint.2023.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Abstract
Background Various studies have examined the relationship between preoperative mental health diagnoses (MHDs) and postoperative outcomes in orthopedic shoulder patients. However, few investigations delve into the relationship between a preoperative MHD and postoperative opioid pain control regimens in patients who have undergone rotator cuff repair (RCR), total shoulder arthroplasty (TSA), and reverse TSA (rTSA). We hypothesize that orthopedic shoulder patients with a preoperative MHD will be prescribed more opioids (ie, request more refills) postoperatively than those without a MHD. Methods An institutional review board-approved retrospective chart review was performed on 438 patients, 18 years or older, who underwent RCR, TSA, or rTSA. Patients were divided into two groups: those diagnosed with depression, anxiety, bipolar disorder, and/or schizophrenia (n = 193), and those with no previous MHD (n = 245). Statistical outcomes were analyzed with the independent t-test, Mann-Whitney U test, one-way Analysis of Variance, and Kruskal-Wallis test. Results Univariate analysis demonstrated significant differences between the MHD group and non-MHD group in average 90-day postoperative opioid scripts (2.10 vs. 1.55, respectively, P < .001) and median 90-day postoperative morphine milligram equivalents (MMEs) prescribed (225 MME vs. 185.25 MME, respectively, P < .001). Among patients who were opioid naive 90 days preoperatively, significant differences were found in MMEs prescribed between the MHD and non-MHD group (225 MME vs. 150 MME, respectively, P < .001). Further analysis of opioid naive patients with specifically depression compared to patients with an alternate or no MHD diagnosis yielded significant differences in scripts (1.78 vs. 1.33, respectively, P = .031) and MMEs prescribed (225 MME vs. 150 MME, respectively, P < .001). Conclusion This study found that RCR, TSA, or rTSA patients with a preoperative MHD were prescribed significantly more postoperative MMEs and more opioid scripts (ie, requested more refills) than those without MHD. This is despite preoperative education on postoperative pain expectations and limiting opioid use. Our findings support our hypothesis and emphasize the clinical importance of recognizing mental health disease while navigating postoperative pain control expectations. Given the rising prevalence of mental health disorders nationwide, considering the effect of these comorbidities on postoperative pain in RCR, TSA, and rTSA patients will be essential to enhance preoperative and postoperative counseling and management by orthopedic surgeons. We further recommend a multidisciplinary approach to help manage pain in these patients.
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Affiliation(s)
| | | | | | - Pietro Gentile
- Department of Orthopedic Surgery, Cooper University Healthcare, Camden, NJ, USA
| | - Krystal Hunter
- Cooper Medical School of Rowan University, Camden, NJ, USA
- Department of Orthopedic Surgery, Cooper University Healthcare, Camden, NJ, USA
| | - Catherine J. Fedorka
- Cooper Medical School of Rowan University, Camden, NJ, USA
- Department of Orthopedic Surgery, Cooper University Healthcare, Camden, NJ, USA
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Abed V, Khalily CD, Landy DC, Lemaster NG, Stone AV. Risk Factors Associated With Prolonged Opioid Use After Revision Total Shoulder Arthroplasty. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202311000-00013. [PMID: 37976449 PMCID: PMC10659687 DOI: 10.5435/jaaosglobal-d-23-00118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/20/2023] [Accepted: 10/10/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION The purpose of this study was to determine which preoperative factors are associated with prolonged opioid use after revision total shoulder arthroplasty (TSA). METHODS The M157Ortho PearlDiver database was used to identify patients undergoing revision TSA between 2010 and 2021. Opioid use for longer than 1 month after surgery was defined as prolonged opioid use. Postoperative opioid use from 1 to 3 months was independently assessed. Multivariable logistic regression was used to evaluate the association between preoperative patient-related risk factors (age, Charlson Comorbidity Index, sex, depression, anxiety, substance use disorder, opioid use between 12 months to 1 week of surgery, tobacco use, hypertension, diabetes mellitus, chronic obstructive pulmonary disease, osteoporosis, previous myocardial infarction, and chronic ischemic heart disease) with prolonged postoperative opioid use. Odds ratios (OR) and their associated 95% confidence intervals (CI) were calculated for each risk factor. RESULTS A total 14,887 patients (mean age = 67.1 years) were included. Most of the patients were female (53.3%), and a large proportion were opioid familiar (44.1%). Three months after revision TSA, older age (OR = 0.96, CI 0.96 to 0.97) and male sex (OR = 0.90, CI 0.81 to 0.99) were associated with a decreased risk of prolonged postoperative opioid usage. Patients with preexisting depression (OR = 1.21, CI 1.08 to 1.35), substance use disorder (OR = 1.47, CI 1.29 to 1.68), opioid use (OR = 16.25, CI 14.27 to 18.57), and chronic obstructive pulmonary disorder (OR = 1.24, CI 1.07 to 1.42) were at an increased risk of prolonged postoperative opioid use. DISCUSSION Older age and male sex were associated with a decreased risk of prolonged opioid use after revision TSA. Depression, substance use disorder, opioid familiarity, and COPD were associated with prolonged opioid use after revision TSA.
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Affiliation(s)
- Varag Abed
- From the Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, KY
| | - Camille D. Khalily
- From the Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, KY
| | - David C. Landy
- From the Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, KY
| | - Nicole G. Lemaster
- From the Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, KY
| | - Austin V. Stone
- From the Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, KY
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Kamma SA, Pathapati RK, Somerson JS. Smoking cessation prior to total shoulder arthroplasty: A systematic review of outcomes and complications. Shoulder Elbow 2023; 15:484-496. [PMID: 37811391 PMCID: PMC10557933 DOI: 10.1177/17585732221131916] [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: 03/03/2022] [Revised: 07/18/2022] [Accepted: 09/13/2022] [Indexed: 10/10/2023]
Abstract
Background We conducted a review of current literature to examine the effects of smoking and smoking cessation on shoulder arthroplasty surgery. Methods A literature search was performed using the search terms "shoulder arthroplasty AND [smoke OR smoking OR tobacco OR nicotine]." Studies included English-language clinical outcomes studies on anatomic total shoulder arthroplasty (TSA), reverse TSA, and partial shoulder arthroplasty with evidence levels 1 through 4. Descriptive statistics calculated in the included studies were used during the analysis. Categorical variables were reported as proportions, while continuous variables were reported as means with minimum to maximum absolute ranges. Results Twenty-four studies were included and analyzed. Following TSA, patients who quit smoking at least 1 month preoperatively had improved outcomes compared to current smokers. Current smokers had statistically significant higher pain scores or opioid use. Five studies found increased rates of revision surgery in smokers. Smokers were significantly (p < 0.05) more likely to have increased rates of surgical, wound, superficial, and deep surgical site complications. Discussion Former smokers had lower complication rates and visual analog scale scores when compared to current users. A period of four weeks or more of preoperative smoking cessation is recommended. Level of Evidence Level III, Systematic Review.
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Affiliation(s)
- Sai A Kamma
- John Sealy School of Medicine, The University of Texas Medical Branch, Galveston, TX, USA
| | - Rajeev K Pathapati
- School of Medicine, The University of Texas Health Science Center – San Antonio, San Antonio, TX, USA
| | - Jeremy S Somerson
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX, USA
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Liu S, Stevens JA, Collins AE, Duff J, Sutherland JR, Oddie MD, Naylor JM, Patanwala AE, Suckling BM, Penm J. Prevalence and predictors of long-term opioid use following orthopaedic surgery in an Australian setting: A multicentre, prospective cohort study. Anaesth Intensive Care 2023; 51:321-330. [PMID: 37688433 PMCID: PMC10493038 DOI: 10.1177/0310057x231172790] [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] [Indexed: 09/10/2023]
Abstract
Opioid analgesics prescribed for the management of acute pain following orthopaedic surgery may lead to unintended long-term opioid use and associated patient harms. This study aimed to examine the prevalence of opioid use at 90 days after elective orthopaedic surgery across major city, regional and rural locations in New South Wales, Australia. We conducted a prospective, observational cohort study of patients undergoing elective orthopaedic surgery at five hospitals from major city, regional, rural, public and private settings between April 2017 and February 2020. Data were collected by patient questionnaire at the pre-admission clinic 2-6 weeks before surgery and by telephone call after 90 days following surgery. Of the 361 participants recruited, 54% (195/361) were women and the mean age was 67.7 years (standard deviation 10.1 years). Opioid use at 90 or more days after orthopaedic surgery was reported by 15.8% (57/361; 95% confidence interval (CI) 12.2-20%) of all participants and ranged from 3.5% (2/57) at a major city location to 37.8% (14/37) at an inner regional location. Predictors of long-term postoperative opioid use in the multivariable analysis were surgery performed at an inner regional location (adjusted odds ratio 12.26; 95% CI 2.2-68.24) and outer regional location (adjusted odds ratio 5.46; 95% CI 1.09-27.50) after adjusting for known covariates. Long-term opioid use was reported in over 15% of patients following orthopaedic surgery and appears to be more prevalent in regional locations in Australia.
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Affiliation(s)
- Shania Liu
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Department of Pharmacy, Prince of Wales Hospital, Randwick, Australia
| | - Jennifer A Stevens
- School of Medicine, Notre Dame University, Sydney, Australia
- St Vincent’s Clinical School, University of New South Wales, Kensington, Australia
| | | | - Jed Duff
- Faculty of Health, Queensland University of Technology, Kelvin Grove, Australia
| | - Joanna R Sutherland
- Rural Clinical School Coffs Harbour Campus, University of New South Wales, Coffs Harbour, Australia
| | | | - Justine M Naylor
- Whitlam Orthopaedic Research Centre, Ingham Institute, Liverpool, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Asad E Patanwala
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Department of Pharmacy, Royal Prince Alfred Hospital, Sydney, Australia
| | - Benita M Suckling
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Pharmacy Department, Caboolture, Kilcoy and Woodford Directorate, Metro North Health, Caboolture, Australia
| | - Jonathan Penm
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Department of Pharmacy, Prince of Wales Hospital, Randwick, Australia
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Diei C, Mehdipour S, Wall PV, Gabriel RA. The association of depression and anxiety with postoperative opioid use following total joint arthroplasty. Heliyon 2023; 9:e18813. [PMID: 37576284 PMCID: PMC10415873 DOI: 10.1016/j.heliyon.2023.e18813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 07/08/2023] [Accepted: 07/28/2023] [Indexed: 08/15/2023] Open
Abstract
Background The devastating opioid epidemic in the United States has been exacerbated by health care practices as well as underlying individual factors. Total joint arthroplasty (TJA) is one of the most common surgical procedures performed annually and patients frequently require opioids for pain control. Patient anxiety and depression has been shown to be associated with increased pain and poorer outcomes after TJA. Our study sought to determine if there was an association between depression/anxiety and postoperative opioid use following TJA. Methods In this retrospective cohort study, postoperative outcomes after TJA were compared among three cohorts of patients: 1) no depression; 2) mild depression; or 3) moderate or severe depression at our institution from 2017 to 2019. Our primary outcome was persistent opioid use ≥3 months after surgery. Secondary outcomes included postoperative day 1 opioid consumption and hospital length of stay (LOS). Multivariable regression modeling was performed to control for various potential confounders. Results Of the 542 total patients that met inclusion criteria for this study, 53 (9.8%) had mild depression and 67 (12.4%) had moderate or severe depression. Persistent opioid use ≥3 months after surgery was found in 132 (24.3%) patients. Mild depression was associated with increased odds of persistent opioid use (odds ratio 4.11, 95% confidence interval 1.65-10.18, P = 0.002). Depression was not associated with immediate postoperative opioid use or hospital LOS. Conclusion Mild depression was associated with persistent opioid use after surgery. Future studies should investigate if better management of this comorbidity could improve outcomes in patients undergoing joint arthroplasty.
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Affiliation(s)
- Crystal Diei
- Division of Perioperative Informatics, Department of Anesthesiology, University of California, San Diego, La Jolla, CA, USA
| | - Soraya Mehdipour
- Division of Perioperative Informatics, Department of Anesthesiology, University of California, San Diego, La Jolla, CA, USA
| | - Pelle V Wall
- School of Medicine, Department of Anesthesiology, University of California, San Diego, La Jolla, CA, USA
| | - Rodney A Gabriel
- Division of Perioperative Informatics, Department of Anesthesiology, University of California, San Diego, La Jolla, CA, USA
- Department of Biomedical Informatics, Department of Anesthesiology, University of California, San Diego, La Jolla, CA, USA
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Terkawi AS, Ottestad E, Altirkawi OK, Salmasi V. Transitional Pain Medicine; New Era, New Opportunities, and New Journey. Anesthesiol Clin 2023; 41:383-394. [PMID: 37245949 DOI: 10.1016/j.anclin.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Chronic postsurgical pain (CPSP), also known as persistent postsurgical pain (PPSP), is pain that develops or increases in intensity after a surgical procedure and lasts more than 3 months. Transitional pain medicine is the medical field that focuses on understanding the mechanisms of CPSP and defining risk factors and developing preventive treatments. Unfortunately, one significant challenge is the risk of developing opioid use dependence. Multiple risk factors have been discovered, with the most common, and modifiable, being uncontrolled acute postoperative pain; preoperative anxiety and depression; and preoperative site pain, chronic pain, and opioid use.
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Affiliation(s)
- Abdullah Sulieman Terkawi
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.
| | - Einar Ottestad
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Omar Khalid Altirkawi
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Vafi Salmasi
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
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Jones CA, Throckmorton TW, Murphy J, Eason RR, Joyce M, Bernholt DL, Azar FM, Brolin TJ. Opioid-sparing pain management protocol after shoulder arthroplasty results in less opioid consumption and higher satisfaction: a prospective, randomized controlled trial. J Shoulder Elbow Surg 2022; 31:2057-2065. [PMID: 35803549 DOI: 10.1016/j.jse.2022.05.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 05/19/2022] [Accepted: 05/30/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND The opioid epidemic has become a central focus in health care. In an effort to reduce opioid use, orthopedic surgeons use multimodal strategies to control postoperative pain. However, no clear consensus exists on ideal pain management strategies after shoulder arthroplasty, and most protocols are opioid-driven. This study sought to determine if patients undergoing shoulder arthroplasty using a postoperative opioid-sparing pain-control regimen would have equivalent pain scores and satisfaction as patients using a traditional opioid-based regimen. METHODS Patients undergoing primary anatomic or reverse total shoulder arthroplasty were prospectively enrolled and randomized into an opioid-sparing (OS) or a traditional opioid-based (OB) postoperative pain protocol. Both groups received opioid education, periarticular injection with liposomal bupivacaine, and preoperative and postoperative multimodal management (acetaminophen, celecoxib, and gabapentin). The OB group was discharged with 40 oxycodone tablets and standard icing, whereas the OS group received ketorolac during admission, continuous cryotherapy, and discharged with 10 oxycodone tablets for rescue. Patients were queried regarding levels of pain and opioid consumption at days 1-7 and at 2, 6, and 12 weeks postoperatively. Patient satisfaction was recorded at 1, 2, 6, and 12 weeks. Range of motion (ROM), American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), and Single Assessment Numerical Evaluation (SANE) scores were assessed preoperatively and at 12 weeks postoperatively. Complications, readmissions, and reoperations were recorded. RESULTS In 78 patients, no difference in VAS pain scores were seen at any time between groups. The OS group consumed less oral morphine equivalents (OME) from inpatient hospitalization to 12 weeks postoperatively (P < .05). Total OME consumption was reduced by 213% for the OS vs. the OB group (112 vs. 239; P < .0001). The OS group consumed fewer opioid pills at all time points (P < .05). A 395% reduction in number of opioid pills consumed in the first 12 weeks postoperatively was seen in the OS vs. the OB group (4.3 vs. 17.0; P < .0001). Significantly more patients in the OS group discontinued opioids by 2 weeks postoperatively (86.1% vs. 58.5%; P = .011), and 94.4% in the OS group discontinued opioids by 6 weeks postoperatively. The OS group was more satisfied with pain management at 1 and 6 weeks (P = .05). No difference in ROM, ASES or SANE scores, complications, readmissions, or reoperations were seen between groups. CONCLUSIONS This study demonstrated a nearly 4-fold reduction in opioid pain pill consumption and earlier cessation of opioids with an OS pain management protocol. Patients also reported higher satisfaction with this pain management strategy.
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Affiliation(s)
- Caleb A Jones
- University of Tennessee Health Science Center, Campbell Clinic Department of Orthopaedic Surgery and Biomedical Engineering, Memphis, TN, USA
| | - Thomas W Throckmorton
- University of Tennessee Health Science Center, Campbell Clinic Department of Orthopaedic Surgery and Biomedical Engineering, Memphis, TN, USA
| | - Jeff Murphy
- Murphy Statistical Services, Warsaw, IN, USA
| | | | - Myles Joyce
- Campbell Clinic Foundation, Memphis, TN, USA
| | - David L Bernholt
- University of Tennessee Health Science Center, Campbell Clinic Department of Orthopaedic Surgery and Biomedical Engineering, Memphis, TN, USA
| | - Frederick M Azar
- University of Tennessee Health Science Center, Campbell Clinic Department of Orthopaedic Surgery and Biomedical Engineering, Memphis, TN, USA
| | - Tyler J Brolin
- University of Tennessee Health Science Center, Campbell Clinic Department of Orthopaedic Surgery and Biomedical Engineering, Memphis, TN, USA.
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Ross BJ, Wortman RJ, Lee OC, Mansour AA, Cole WW, Sherman WF. Is Prior Hip Arthroscopy Associated With Higher Complication Rates or Prolonged Opioid Claims After Total Hip Arthroplasty? A Matched Cohort Study. Orthop J Sports Med 2022; 10:23259671221126508. [PMID: 36199826 PMCID: PMC9528006 DOI: 10.1177/23259671221126508] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 07/27/2022] [Indexed: 12/03/2022] Open
Abstract
Background: Hip arthroscopy (HA) procedures have increased exponentially in recent years. Their effect on outcomes after subsequent total hip arthroplasty (THA) remains unclear. Purpose: To compare rates of complications and opioid claims after elective THA among patients with prior HA versus controls. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent THA were identified in the PearlDiver database. Arthroplasty performed for hip fractures and hip avascular necrosis were excluded. Within this population, patients with HA before arthroplasty (n = 3156) were propensity score matched 1:1 with controls on age, sex, US region, and several comorbidities. Rates of medical complications within 90 days and prosthesis-related complications within 2 years were queried. The number of patients with an opioid claim within 0 to 30 days and subsequent opioid claim(s) during the 90-day global period were obtained to assess rates of prolonged opioid use after arthroplasty. Rates of postoperative complications and opioid claims were compared using logistic regression. Results: Patients with prior HA exhibited significantly lower rates of readmission (5.6% vs 7.3%; odds ratio [OR], 0.72), pulmonary embolism (0.2% vs 0.6%; OR, 0.45), urinary tract infection (3.1% vs 4.0%; OR, 0.75), and blood transfusion (3.6% vs 6.1%; OR, 0.55). The prior HA cohort also exhibited a significantly lower rate of prosthetic joint infection at 1 year postoperatively (0.6% vs 1.3%; OR, 0.50). Rates of dislocation, periprosthetic fracture, mechanical complications, and aseptic revision arthroplasty were statistically comparable between the cohorts within 2 years. The prior HA cohort was significantly less likely to file persistent opioid claims after 30 days postoperatively, including between 31 and 60 days (27.2% vs 33.1%; OR, 0.74) and 61 to 90 days (16.2% vs 20.9%; OR, 0.71). Conclusion: After elective THA, patients with prior HA exhibited significantly lower rates of medical complications and prolonged opioid claims within 90 days and prosthetic joint infection at 1 year. Rates of all other prosthesis-related complications within 2 years were statistically comparable.
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Affiliation(s)
- Bailey J. Ross
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Ryan J. Wortman
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Orthopaedic Surgery, Albany Medical Center, Albany, New York, USA
| | - Olivia C. Lee
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Orthopaedic Surgery, LSUHSC School of Medicine, New Orleans, Louisiana, USA
| | - Alfred A. Mansour
- Department of Orthopaedic Surgery, University of Texas, McGovern School of Medicine at UTHealth, Houston, Texas, USA
| | - Wendell W. Cole
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - William F. Sherman
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
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10
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Gao X, He N, Xue FS. Assessing analgesic consumption after shoulder arthroplasty. J Anesth 2022; 36:665-666. [PMID: 35819725 DOI: 10.1007/s00540-022-03090-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 06/30/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Xue Gao
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, NO. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, People's Republic of China
| | - Nong He
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, NO. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, People's Republic of China
| | - Fu-Shan Xue
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, NO. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, People's Republic of China.
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11
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Rimmer RA, Scott B, Pailet J, Farrell NF, Mace JC, Detwiller KY, Smith TL, Dogan A, Gupta S, Andersen P, Cetas J, Geltzeiler M. Opioid use after endoscopic skull base surgery: A descriptive, prospective, longitudinal cohort study. Int Forum Allergy Rhinol 2021; 12:160-171. [PMID: 34309220 DOI: 10.1002/alr.22871] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/11/2021] [Accepted: 07/01/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Opioid abuse is a public health crisis and the perioperative period can be a time of first opioid exposure. Little is known about postoperative pain management after endoscopic skull base surgery (ESBS). METHODS This investigation was a single-institution, longitudinal, prospective cohort study of adult patients undergoing ESBS between November 2019 and March 2020. Participants completed preoperative questionnaires and were contacted every 48 hours postoperatively to quantify pain and opioid consumption. RESULTS A total of 33 patients were enrolled and 28 of 33 patients (85%) underwent ESBS for sellar pathology. Mean total morphine milligram equivalents (MME) consumed was 381.9 ± 476.0. History of a headache disorder (p = 0.025) and previous opioid use within 60 days preoperatively (p < 0.001) were significantly associated with greater opioid use. Mean duration of opioid use was 6.7 ± 5.1 (range, 0-20) days. Headache disorder (p = 0.01), depression (p = 0.03), anxiety (p = 0.03), age ≤46 years (p = 0.029), and previous opioid use (p = 0.008) were all associated with longer mean opioid use. Patients with headache disorder also reported higher mean postoperative pain scores. Fewer than half of the participants required opioids by postoperative day 8. Prescription of nonsteroidal anti-inflammatory drugs at discharge was significantly associated with less outpatient opioid use (p = 0.032). At 2-month follow-up, 37% of patients reported keeping excess opioids. CONCLUSION After ESBS, greater total opioid use was significantly associated with history of headaches and previous opioid use within 60 days. Overall, opioid use declined among all patients in the postoperative period, but several factors may contribute to longer duration of use.
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Affiliation(s)
- Ryan A Rimmer
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, OR
| | - Brian Scott
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, OR
| | - Jasmina Pailet
- School of Medicine, Oregon Health and Science University, Portland, OR
| | - Nyssa Fox Farrell
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St. Louis, St. Louis, MO
| | - Jess C Mace
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, OR
| | - Kara Y Detwiller
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, OR
| | - Timothy L Smith
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, OR
| | - Aclan Dogan
- Department of Neurological Surgery, Oregon Health and Science University, Portland, OR
| | - Sachin Gupta
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, OR
| | - Peter Andersen
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, OR
| | - Justin Cetas
- Department of Neurological Surgery, Oregon Health and Science University, Portland, OR
| | - Mathew Geltzeiler
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, OR
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