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Alessio-Bilowus D, Luby AO, Cooley S, Evilsizer S, Seese E, Bicket M, Waljee JF. Perioperative Opioid-Related Harms: Opportunities to Minimize Risk. Semin Plast Surg 2024; 38:61-68. [PMID: 38495063 PMCID: PMC10942841 DOI: 10.1055/s-0043-1778043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Although substantial attention has been given to opioid prescribing in the United States, opioid-related mortality continues to climb due to the rising incidence and prevalence of opioid use disorder. Perioperative care has an important role in the consideration of opioid prescribing and the care of individuals at risk for poor postoperative pain- and opioid-related outcomes. Opioids are effective for acute pain management and commonly prescribed for postoperative pain. However, failure to align prescribing with patient need can result in overprescribing and exacerbate the flow of unused opioids into communities. Conversely, underprescribing can result in the undertreatment of pain, complicating recovery and impairing well-being after surgery. Optimizing pain management can be particularly challenging for individuals who are previously exposed to opioids or have critical risk factors, including opioid use disorder. In this review, we will explore the role of perioperative care in the broader context of the opioid epidemic in the United States, and provide considerations for a multidisciplinary, comprehensive approach to perioperative pain management and optimal opioid stewardship.
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Affiliation(s)
- Dominic Alessio-Bilowus
- Section of Plastic Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
- Opioid Prescribing Engagement Network, Ann Arbor, Michigan
| | - Alexandra O. Luby
- Section of Plastic Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan
| | | | | | | | - Mark Bicket
- Opioid Prescribing Engagement Network, Ann Arbor, Michigan
- Division of Pain Research, Department of Anesthesiology, Michigan Medicine, Ann Arbor, Michigan
| | - Jennifer F. Waljee
- Section of Plastic Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
- Opioid Prescribing Engagement Network, Ann Arbor, Michigan
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan
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Abstract
BACKGROUND As craniofacial fellowship positions outnumber the availability of academic craniofacial jobs, it is important to understand the factors associated with securing an academic position after fellowship. The purpose of this study was to evaluate the impact of bibliometric indices and trainee demographics on the ability to obtain a full-time academic plastic surgery position on completion of a craniofacial fellowship. METHODS Craniofacial fellowship graduates between 2009 and 2018 (n = 182) were identified. Initial job placement and demographic data were collected; bibliometric indices at fellowship completion were calculated. Chi-square and Fisher's exact tests and multivariable logistic regression were used to assess the association of select factors with job placement. RESULTS Of the 48.9 percent of fellows that secured academic positions, 39.3 percent trained at five fellowship institutions. The majority of those completing residency at top institutions for academic surgery and research entered academic positions at fellowship completion. Geography influenced academic placement, as 72.7 percent of trainees in the Northeast secured academic positions. Only 20.3 percent of fellows completed dedicated postgraduate research time, but among these, 70.3 percent entered academic jobs. The h-index (OR, 1.14; p = 0.01) and total manuscripts (OR, 1.04; p = 0.02) were significantly associated with academic practice while adjusting for other covariates. CONCLUSIONS Although residency training institution, geographic location, and postgraduate research may influence academic placement, the h-index and total manuscripts represent the best predictors of academic careers after craniofacial fellowship. This information is valuable for applicants who aspire to be academic craniofacial surgeons, and for programs and educators who can use these data to identify applicants with a propensity for academics.
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Affiliation(s)
- Alexandra O Luby
- From the Department of Surgery, Section of Plastic and Reconstructive Surgery, Craniofacial Research Laboratory, University of Michigan Health System
| | - Kavitha Ranganathan
- From the Department of Surgery, Section of Plastic and Reconstructive Surgery, Craniofacial Research Laboratory, University of Michigan Health System
| | - Niki Matusko
- From the Department of Surgery, Section of Plastic and Reconstructive Surgery, Craniofacial Research Laboratory, University of Michigan Health System
| | - Steven R Buchman
- From the Department of Surgery, Section of Plastic and Reconstructive Surgery, Craniofacial Research Laboratory, University of Michigan Health System
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Luby AO, Subramanian C, Buchman LK, Lynn JV, Urlaub KM, Nelson NS, Donneys A, Cohen MS, Buchman SR. Amifostine Prophylaxis in Irradiated Breast Reconstruction: A Study of Oncologic Safety In Vitro. Ann Plast Surg 2020; 85:424-429. [PMID: 31850964 PMCID: PMC7295666 DOI: 10.1097/sap.0000000000002110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Indications for adjuvant radiation therapy (XRT) in breast cancer have expanded. Although highly effective, XRT damages surrounding tissues and vasculature, often resulting in delayed or compromised breast reconstruction. Thus, effective yet safe methods of radiation injury prophylaxis would be desirable. Amifostine is a Food and Drug Administration-approved radioprotectant; however, concerns about its potential to also protect cancer remain. The purpose of this study was to evaluate the oncologic safety of amifostine (AMF) in vitro and determine its effect on human breast cancer cells in the setting of XRT. METHODS One ER+/PR+/Her2- (MCF-7) and two ER-/PR-Her2- (MDA-MB-231, MDA-MB-468) breast cancer cell lines were investigated. Female fibroblasts were used as controls. Cells were treated with WR-1065, the active metabolite of AMF, 20 minutes before 0Gy, 10Gy, or 20Gy XRT. Live and dead cells were quantified; percent cell death was calculated. RESULTS WR-1065 treatment significantly preserved viability and reduced healthy female fibroblasts death after XRT compared with untreated controls. All three breast cancer cells lines exhibited radiosensitivity with substantial cell death. Cancer cells retained their radiosensitivity despite WR-1065 pretreatment, achieving the same degree of cell death as untreated controls. CONCLUSIONS This study demonstrated the proficiency of AMF to selectively protect healthy cells from XRT while breast cancer cells remained radiosensitive. These results support the oncologic safety of AMF in breast cancer in vitro. Further investigation is now warranted in vivo to ascertain the translational potential of using AMF as a radioprotectant to improve breast reconstruction after radiation treatment.
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Affiliation(s)
| | - Chitra Subramanian
- Section of General Surgery, Department of Surgery, University of Michigan Health Systems, Ann Arbor, MI
| | | | | | | | | | | | - Mark S Cohen
- Section of General Surgery, Department of Surgery, University of Michigan Health Systems, Ann Arbor, MI
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Lynn JV, Ranganathan K, Bageris MH, Luby AO, Tursak HR, Hart-Johnson T, Blackwood RA, Buchman SR. Sociodemographic Predictors of Patient Age at Time of Cleft Lip and Palate Repair. Cleft Palate Craniofac J 2020; 57:1402-1409. [DOI: 10.1177/1055665620949119] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: To identify the impact of sociodemographic and health variables on the age at which patients undergo cleft lip repair, cleft palate repair, and primary speech evaluation. Design: A retrospective, noninterventional quality assessment, and quality improvement study was designed. Setting: This institutional study was performed at Michigan Medicine in Ann Arbor, MI. Patients: All patients born between 2011 and 2014 who received surgical cleft repair, excluded those who were adopted (n = 165). Main Outcome Measure: The age at which patients undergo cleft lip repair, cleft palate repair, and primary speech evaluation. Results: Cleft lip repair was performed significantly later for patients identifying as Asian (18 weeks, P = .01), patients with Child Protective Services contact (19 weeks, P = .01), patients with a significant comorbidity (14 weeks, P = .02), and patients who underwent preliminary lip adhesion surgery (19 weeks, P < .01). Cleft palate repair was performed significantly later for patients identifying racially as Asian (19 weeks, P = .03) and other (22 weeks, P = .03). Preliminary speech and language evaluation were performed significantly later for patients identifying as black (55 weeks, P = .03) and patients diagnosed with an isolated cleft lip (71 weeks, P < .01). Conclusions: Timing of cleft lip, cleft palate repair, and primary speech and language evaluation are subject to variation which may be predicted by clinically accessible factors. By identifying race, Child Protective Services contact, and care variables as significant predictors of increased patient age at time of intervention, multidisciplinary cleft care teams can proactively allocate patient support resources.
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Affiliation(s)
- Jeremy V. Lynn
- Section of Plastic and Reconstructive Surgery, University of Michigan, Ann Arbor, MI, USA
- Office for Health Equity and Inclusion, University of Michigan, Ann Arbor, MI, USA
| | - Kavitha Ranganathan
- Section of Plastic and Reconstructive Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Matthew H. Bageris
- Section of Plastic and Reconstructive Surgery, University of Michigan, Ann Arbor, MI, USA
- Office for Health Equity and Inclusion, University of Michigan, Ann Arbor, MI, USA
| | - Alexandra O. Luby
- Section of Plastic and Reconstructive Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Hailey R. Tursak
- Office for Health Equity and Inclusion, University of Michigan, Ann Arbor, MI, USA
| | - Tami Hart-Johnson
- Office for Health Equity and Inclusion, University of Michigan, Ann Arbor, MI, USA
| | - R. Alexander Blackwood
- Office for Health Equity and Inclusion, University of Michigan, Ann Arbor, MI, USA
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Steven R. Buchman
- Section of Plastic and Reconstructive Surgery, University of Michigan, Ann Arbor, MI, USA
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