Background-Opioid dependence, misuse, and abuse in the United States continue to rise. Prior studies indicate an important risk factor for persistent opioid use includes elective surgical procedures, though the probability following thoracic procedures remains unknown. We analyzed the incidence and factors associated with new persistent opioid use after lung resection Methods-We evaluated data from opioid-naïve cancer patients undergoing lung resection between 2010 and 2014 using insurance claims from the Truven Health MarketScan Databases. New persistent opioid usage was defined as continued opioid prescription fills between 90 and 180 days following surgery. Variables with p<0.10 by univariate analysis were included in a multivariable logistic regression performed for risk adjustment. Multivariable results were each reported with odds ratio (OR) and confidence interval (CI) Results-3,026 patients (44.8% male; 55.2% female) were identified as opioid-naïve undergoing lung resection. Mean age was 64 ± 11 years and mean postoperative length of stay (LOS) was 5.2±3.3 days. 6.5% underwent neoadjuvant therapy, while 21.7% underwent adjuvant therapy. Among opioid-naïve patients, 14% continued to fill opioid prescriptions following lung resection. Multivariable analysis showed that age ≤ 64 (OR 1.28 [CI 1.03-1.59], p=0.028), male sex (1.40 [1.13-1.73], p=0.002), postoperative LOS (1.32 [1.05-1.65], p=0.016), thoracotomy (1.58 [1.24-2.02], p<0.001), and adjuvant therapy (2.19 [1.75-2.75], p<0.001) were independent risk factors for persistent opioid usage Conclusions-The greatest risk factors for persistent opioid use (14%) following lung resection were adjuvant therapy and thoracotomy. Future studies should focus on reducing excess prescribing, perioperative patient education, and safe opioid disposal.
INTRODUCTION Better measures of liver transplant risk stratification are needed. Our previous work noted a strong relationship between psoas muscle area and survival following liver transplantation. The dorsal muscle group is easier to measure but it is unclear if they are also correlated with surgical outcomes. METHODS Our study population included liver transplant recipients with a preoperative CT scan. Cross-sectional areas of the dorsal muscle group at the T12 vertebral level were measured. The primary outcomes for this study were 1 and 5-year mortality and 1-year complications. The relationship between dorsal muscle group area and post-transplantation outcome was assessed using univariate and multivariate techniques. RESULTS Dorsal muscle group area measurements were strongly associated with psoas area (r = 0.72; p < 0.001). Postoperative outcome was observed from 325 patients. Multivariate logistic regression revealed dorsal muscle group area to be a significant predictor of 1-year mortality (odds ratio [OR] = 0.53, p = 0.001,) and 5-year mortality (OR = 0.53, p < 0.001), and 1-year complications (OR = 0.67, p = 0.007). CONCLUSION Larger dorsal muscle group muscle size is associated with improved post-transplantation outcomes. The muscle is easier to measure and may represent a clinically relevant postoperative risk factor.
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