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Santosa KB, Priest CR, Oliver JD, Kenney B, Bicket MC, Brummett CM, Waljee JF. Long-term Health Outcomes of New Persistent Opioid Use After Surgery Among Medicare Beneficiaries. Ann Surg 2023; 278:e491-e495. [PMID: 36375090 DOI: 10.1097/sla.0000000000005752] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 11/16/2022]
Abstract
OBJECTIVE We examined long-term health outcomes associated with new persistent opioid use after surgery and hypothesized that patients with new persistent opioid use would have poorer overall health outcomes compared with those who did not develop new persistent opioid use after surgery. BACKGROUND New persistent opioid use is a common surgical complication. Long-term opioid use increases risk of mortality, fractures, and falls; however, less is known about health care utilization among older adults with new persistent opioid use after surgical care. METHODS We analyzed claims from a 20% national sample of Medicare beneficiaries ≥65 years undergoing surgery between January 1, 2009, and June 30, 2019. We estimated associations between new persistent use and subsequent health events between 6 and 12 months after surgery, including mortality, serious fall/fall-related injury, and respiratory or opioid/pain-related readmission/emergency department (ED) visits using a Cox proportional hazards model to estimate mortality and multivariable logistic regression for the remaining outcomes, adjusting for demographic/clinical characteristics. Our primary outcome was mortality within 6 to 12 months after surgery. Secondary outcomes included falls and readmissions or ED visits (respiratory, pain related/opioid related) within 6 to 12 months after surgery. RESULTS Of 229,898 patients, 6874 (3.0%) developed new persistent opioid use. Compared with patients who did not develop new persistent opioid use, patients with new persistent opioid use had a higher risk of mortality (hazard ratio 3.44, CI, 2.99-3.96), falls [adjusted odds ratio (aOR): 1.21, 95% CI, 1.05-1.39], and respiratory-related (aOR: 1.67, 95% CI, 1.49-1.86) or pain-related/opioid-related (aOR: 1.68, 95% CI, 1.55-1.82) readmissions/ED visits. CONCLUSIONS New persistent opioid use after surgery is associated with increased mortality and poorer health outcomes after surgery. Although the mechanisms that underlie this risk are not clear, persistent opioid use may also be a marker for greater morbidity requiring more care in the late postoperative period. Increased awareness of individuals at risk for new persistent use after surgery and close follow-up in the late postoperative period is critical to mitigate the harms associated with new persistent use.
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Affiliation(s)
| | - Caitlin R Priest
- Department of Surgery, Section of Plastic Surgery, University of Michigan, Ann Arbor, MI
| | - Jeremie D Oliver
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT
| | - Brooke Kenney
- Michigan Opioid Prescribing Engagement Network (Michigan OPEN), Ann Arbor, MI
| | - Mark C Bicket
- Division of Pain Medicine, Department of Anesthesia, University of Michigan, Ann Arbor, MI
- Opioid Prescribing Engagement Network, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
| | - Chad M Brummett
- Division of Pain Medicine, Department of Anesthesia, University of Michigan, Ann Arbor, MI
- Opioid Prescribing Engagement Network, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
| | - Jennifer F Waljee
- Department of Surgery, Section of Plastic Surgery, University of Michigan, Ann Arbor, MI
- Opioid Prescribing Engagement Network, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
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Priest CR, Waljee JF, Bicket MC, Hu HM, Chua KP. Comparison of Opioids Prescribed by Advanced Practice Clinicians vs Surgeons After Surgical Procedures in the US. JAMA Netw Open 2023; 6:e2249378. [PMID: 36598786 PMCID: PMC9857656 DOI: 10.1001/jamanetworkopen.2022.49378] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/11/2022] [Indexed: 01/05/2023] Open
Abstract
Importance Advanced practice clinicians (APCs), defined as nurse practitioners and physician assistants, are increasingly being incorporated into surgical teams. Despite this inclusion, there are no recent national data on the role of these clinicians in surgical opioid prescribing or the dosing of such prescriptions. Objective To calculate the proportion of surgical opioid prescriptions written by APCs and to compare the total and daily dosages of these prescriptions with those written by surgeons. Design, Setting, and Participants This cross-sectional study used the Optum's De-Identified Clinformatics Data Mart, which contains deidentified claims from patients with private insurance and Medicare Advantage plans across the US. Adults and children who underwent 1 of 31 inpatient and outpatient surgical procedures from January 1, 2017, through November 30, 2019, were identified. The analysis was limited to procedures with 1 or more perioperative opioid prescriptions, defined as an opioid prescription dispensed within 3 days of the index date of surgery. Data were analyzed from April 1, 2021, to July 31, 2022. Exposures Prescriber specialty. Main Outcomes and Measures The outcome was the proportion of perioperative opioid prescriptions and refill prescriptions written by APCs. Linear regression was used to compare the total dosage of perioperative opioid prescriptions written by APCs vs surgeons measured in morphine milligram equivalents (MMEs). Models were adjusted for demographic characteristics, comorbidities, opioid-naive status, year of index date, hospitalization or observation status, surgical complications, and surgeon specialty. Analyses were conducted at the procedure level, and patients with multiple procedures were included. Results Analyses included 628 197 procedures for 581 387 patients (358 541 females [57.1%]; mean [SD] age, 56 [18] years). Overall, APCs wrote 119 266 (19.0%) of the 628 197 perioperative opioid prescriptions and 59 679 (25.1%) of the 237 740 refill prescriptions. Perioperative opioid prescriptions written by APCs had higher total dosages compared with those written by surgeons (adjusted difference, 40.0 MMEs; 95% CI, 31.3-48.7 MMEs). This difference persisted in a subgroup analysis limited to opioid-naïve patients (adjusted difference, 15.7 MMEs; 95% CI, 13.9-17.5 MMEs). Conclusions and Relevance In this cross-sectional analysis, one-fifth of perioperative opioid prescriptions and one-quarter of refill prescriptions were written by APCs. While surgeons wrote most perioperative opioid prescriptions that were intended for perioperative analgesia, higher total dosages from APCs suggest that opioid stewardship initiatives that support the role of APCs may be warranted.
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Affiliation(s)
- Caitlin R. Priest
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor
| | - Jennifer F. Waljee
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor
- Michigan Opioid Prescribing Engagement Network, University of Michigan Medical School, Ann Arbor
| | - Mark C. Bicket
- Michigan Opioid Prescribing Engagement Network, University of Michigan Medical School, Ann Arbor
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor
| | - Hsou-Mei Hu
- Michigan Opioid Prescribing Engagement Network, University of Michigan Medical School, Ann Arbor
| | - Kao-Ping Chua
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan Medical School, Ann Arbor
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor
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Santosa KB, Priest CR, Oliver JD, Bellomo TR, Bonner S, Matusko N, Sandhu G, Waljee JF. Influence of faculty diversity on resident diversity across surgical subspecialties. Am J Surg 2022; 224:273-281. [DOI: 10.1016/j.amjsurg.2022.02.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 01/23/2022] [Accepted: 02/07/2022] [Indexed: 11/25/2022]
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Peleman JR, Chung MT, Johnson J, Rayess H, Priest CR, Hojjat H, Mourad M, Carron MA, Vasconez HC. Surgical Adjuncts to Rhinoplasty: An Algorithmic Approach. Aesthetic Plast Surg 2020; 44:1694-1704. [PMID: 32383001 DOI: 10.1007/s00266-020-01744-9] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 04/23/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Nasal aesthetics can be significantly affected by the interdependence of the surrounding bone and soft tissues of the face. These include the maxilla, septum, frontal bone, mandible, and the soft tissues and cartilage surrounding the nose. Therefore, it is pertinent to analyze and address these critical relationships of the nose in order to achieve a successful rhinoplasty. This work seeks to describe the battery of adjunct procedures available to supplement a rhinoplasty. Furthermore, each preoperative finding or indication for the adjunct is described in an algorithmic fashion. METHODS A literature search using PubMed, Google Scholar, and a university library database was performed to locate papers describing adjunctive procedures to rhinoplasty. Indications and preoperative analysis were extracted from each paper. If the indication or finding was unclear, supplementary literature describing rhinoplasty and adjunctive analysis were sought in order to supplement our findings. RESULTS Sixteen papers in total described adjunctive procedures for rhinoplasty. Each work highlighted a procedure or set of procedures on a surrounding facial feature including the forehead, brow, cheeks, lips, and chin, and neck. In total, 13 adjunct procedures for rhinoplasty are described with their respective indications. Additional literature and techniques were researched to clarify indicated procedures. CONCLUSION The ability to correctly understand the critical relationships of the nose can help the surgeon correctly recognize the indication for a rhinoplasty adjunct procedure, leading to better aesthetic balance and surgical outcomes. LEVEL OF EVIDENCE II This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- John R Peleman
- Wayne State University School of Medicine, Detroit, MI, USA
| | - Michael T Chung
- Department of Otolaryngology - Head and Neck Surgery, Wayne State University, Detroit, MI, USA.
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, Wayne State University, 5E UHC, 4201 St Antoine, Detroit, MI, 48201, USA.
| | - Jared Johnson
- Department of Otolaryngology - Head and Neck Surgery, Wayne State University, Detroit, MI, USA
| | - Hani Rayess
- Department of Otolaryngology - Head and Neck Surgery, University of Tennessee, Memphis, TN, USA
| | | | - Houmehr Hojjat
- Department of Otolaryngology - Head and Neck Surgery, Wayne State University, Detroit, MI, USA
| | - Moustafa Mourad
- MouradNYC Facial Plastic and Reconstructive Surgery, New York City, NY, USA
| | - Michael A Carron
- Department of Otolaryngology - Head and Neck Surgery, Wayne State University, Detroit, MI, USA
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, Wayne State University, 5E UHC, 4201 St Antoine, Detroit, MI, 48201, USA
| | - Henry C Vasconez
- Division of Plastic and Reconstructive Surgery, University of Kentucky, Lexington, KY, USA
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Priest CR, Kenney BC, Brummett CM, Waljee JF, Englesbe MJ, Nalliah RP. Increased opioid prescription fills after dental procedures performed before weekends and holidays. J Am Dent Assoc 2020; 151:388-398.e1. [PMID: 32450977 DOI: 10.1016/j.adaj.2020.03.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 03/02/2020] [Accepted: 03/15/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Excess opioid prescriptions place patients and communities at risk of experiencing opioid-related morbidity. The authors designed a study to test the hypothesis that opioid prescription fills would be more common after dental procedures performed the day before a weekend or holiday than other weekdays. METHODS The authors performed a retrospective cohort study of 2,060,317 people, integrating Truven Health MarketScan insurance claims to evaluate variation in opioid fills for dental procedures performed the day before a weekend or holiday compared with other weekdays. Opioid-naïve people, aged 13 through 64 years, with eligible procedures from 2013 through 2017 were included. The primary outcome measure was a prescription opioid fill on the same date as the dental procedure. RESULTS Multivariable logistic regression results showed significantly higher odds of filling an opioid prescription for patients with procedures the day before weekends and holidays (adjusted odds ratio, 1.27; 95% confidence interval, 1.26 to 1.28) than for patients with procedures on other weekdays. In addition, the youngest age category, 13 through 29 years, had the highest odds of filling an opioid prescription compared with other age categories (reference category: patients aged 50-64 years, adjusted odds ratio, 1.43; 95% confidence interval, 1.41 to 1.44). CONCLUSIONS Outpatient dental procedures performed the day before a weekend or holiday were associated with a 27% increased adjusted odds of filling a prescription for an opioid. PRACTICAL IMPLICATIONS Although patients and dentists might be concerned about the challenges of unmanaged pain on weekends and holidays, opioids are not warranted for most dental procedures and should be replaced with patient education and nonopioid analgesics. Oral health care professionals concerned about postprocedural pain control should consider scheduling complex procedures earlier in the week, when emergency care is available to reduce unwarranted preemptive prescribing of opioids, which might be driving increased opioid fills before weekends and holidays.
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Hsieh HHS, Agarwal S, Cholok DJ, Loder SJ, Kaneko K, Huber A, Chung MT, Ranganathan K, Habbouche J, Li J, Butts J, Reimer J, Kaura A, Drake J, Breuler C, Priest CR, Nguyen J, Brownley C, Peterson J, Ozgurel SU, Niknafs YS, Li S, Inagaki M, Scott G, Krebsbach PH, Longaker MT, Westover K, Gray N, Ninomiya-Tsuji J, Mishina Y, Levi B. Coordinating Tissue Regeneration Through Transforming Growth Factor-β Activated Kinase 1 Inactivation and Reactivation. Stem Cells 2019; 37:766-778. [PMID: 30786091 DOI: 10.1002/stem.2991] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 10/24/2018] [Accepted: 11/24/2018] [Indexed: 12/13/2022]
Abstract
Aberrant wound healing presents as inappropriate or insufficient tissue formation. Using a model of musculoskeletal injury, we demonstrate that loss of transforming growth factor-β activated kinase 1 (TAK1) signaling reduces inappropriate tissue formation (heterotopic ossification) through reduced cellular differentiation. Upon identifying increased proliferation with loss of TAK1 signaling, we considered a regenerative approach to address insufficient tissue production through coordinated inactivation of TAK1 to promote cellular proliferation, followed by reactivation to elicit differentiation and extracellular matrix production. Although the current regenerative medicine paradigm is centered on the effects of drug treatment ("drug on"), the impact of drug withdrawal ("drug off") implicit in these regimens is unknown. Because current TAK1 inhibitors are unable to phenocopy genetic Tak1 loss, we introduce the dual-inducible COmbinational Sequential Inversion ENgineering (COSIEN) mouse model. The COSIEN mouse model, which allows us to study the response to targeted drug treatment ("drug on") and subsequent withdrawal ("drug off") through genetic modification, was used here to inactivate and reactivate Tak1 with the purpose of augmenting tissue regeneration in a calvarial defect model. Our study reveals the importance of both the "drug on" (Cre-mediated inactivation) and "drug off" (Flp-mediated reactivation) states during regenerative therapy using a mouse model with broad utility to study targeted therapies for disease. Stem Cells 2019;37:766-778.
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Affiliation(s)
- Hsiao Hsin Sung Hsieh
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA.,School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA.,Experimental Rheumatology Department, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Shailesh Agarwal
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - David J Cholok
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Shawn J Loder
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Kieko Kaneko
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Amanda Huber
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael T Chung
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Joe Habbouche
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - John Li
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Jonathan Butts
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Jonathan Reimer
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Arminder Kaura
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - James Drake
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Caitlin R Priest
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Joe Nguyen
- School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
| | - Cameron Brownley
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Jonathan Peterson
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Yashar S Niknafs
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Shuli Li
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Maiko Inagaki
- Department of Environmental and Molecular Toxicology, North Carolina State University, Raleigh, North Carolina, USA
| | - Greg Scott
- Knock Out Core, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina, USA
| | - Paul H Krebsbach
- Section of Periodontics, UCLA School of Dentistry, Los Angeles, California, USA
| | - Michael T Longaker
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Kenneth Westover
- Department of Biochemistry, University of Texas Southwestern, Dallas, Texas, USA
| | - Nathanael Gray
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Jun Ninomiya-Tsuji
- Department of Environmental and Molecular Toxicology, North Carolina State University, Raleigh, North Carolina, USA
| | - Yuji Mishina
- School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
| | - Benjamin Levi
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
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