Study Design Retrospective cohort study Objective The aim of this study was to determine the incidence of and risk factors for persistent opioid use after elective cervical and lumbar spine procedures and to quantify postoperative healthcare utilization in this patient population. Methods Patients were retrospectively identified who underwent elective spine surgery for either cervical or lumbar degenerative pathology between November 1, 2013, and September 30, 2018, at a single academic center. Patients were split into 2 cohorts, including patients with and without opioid use at 180-days postoperatively. Baseline patient demographics, underlying comorbidities, surgical variables, and preoperative/postoperative opioid use were assessed. Health resource utilization metrics within 1 year postoperatively (ie, imaging studies, emergency and urgent care visits, hospital readmissions, opioid prescriptions, etc.) were compared between these 2 groups. Results 583 patients met inclusion criteria, of which 16.6% had opioid persistence after surgery. Opioid persistence was associated with ASA score ≥3 (P = .004), diabetes ( P = .019), class I obesity ( P = .012), and an opioid prescription in the 60 days prior to surgery ( P = .006). Independent risk factors for opioid persistence assessed via multivariate regression included multi-level lumbar fusion (RR = 2.957), cervical central stenosis (RR = 2.761), and pre-operative opioid use (RR = 2.668). Opioid persistence was associated with higher rates of health care utilization, including more radiographs ( P < .001), computed tomography (CT) scans (.007), magnetic resonance imaging (MRI) studies ( P = .014), emergency department (ED) visits (.009), pain medicine referrals (P < .001), and spinal injections ( P = .003). Conclusions Opioid persistence is associated with higher rates of health care utilization within 1 year after elective spine surgery.
ImportancePrior investigations in social determinants of health (SDoH) in pediatric head and neck cancer (HNC) have only considered a narrow scope of HNCs, SDoH, and geography while lacking inquiry into the interrelational association of SDoH with disparities in clinical pediatric HNC.ObjectivesTo evaluate the association of SDoH with disparities in HNC among children and adolescents and to assess which specific aspects of SDoH are most associated with disparities in dynamic and regional sociodemographic contexts.Design, Setting, and ParticipantsThis retrospective cohort study included data about patients (aged ≤19 years) with pediatric HNC who were diagnosed from 1975 to 2017 from the Surveillance, Epidemiology, and End Results Program (SEER) database. Data were analyzed from October 2021 to October 2022.ExposuresOverall social vulnerability and its subcomponent contributions from 15 SDoH variables, grouped into socioeconomic status (SES; poverty, unemployment, income level, and high school diploma status), minority and language status (ML; minoritized racial and ethnic group and proficiency with English), household composition (HH; household members aged ≥65 and ≤17 years, disability status, single-parent status), and housing and transportation (HT; multiunit structure, mobile homes, crowding, no vehicle, group quarters). These were ranked and scored across all US counties.Main Outcomes and MeasuresRegression trends were performed in continuous measures of surveillance and survival period and in discrete measures of advanced staging and surgery receipt.ResultsA total of 37 043 patients (20 729 [55.9%] aged 10-19 years; 18 603 [50.2%] male patients; 22 430 [60.6%] White patients) with 30 different HNCs in SEER had significant relative decreases in the surveillance period, ranging from 23.9% for malignant melanomas (mean [SD] duration, lowest vs highest vulnerability: 170 [128] months to 129 [88] months) to 41.9% for non-Hodgkin lymphomas (mean [SD] duration, lowest vs highest vulnerability: 216 [142] months vs 127 [94] months). SES followed by ML and HT vulnerabilities were associated with these overall trends per relative-difference magnitudes (eg, SES for ependymomas and choroid plexus tumors: mean [SD] duration, lowest vs highest vulnerability: 114 [113] months vs 86 [84] months; P &lt; .001). Differences in mean survival time were observed with increasing social vulnerability, ranging from 11.3% for ependymomas and choroid plexus tumors (mean [SD] survival, lowest vs highest vulnerability: 46 [46] months to 41 [48] months; P = .43) to 61.4% for gliomas not otherwise specified (NOS) (mean [SD] survival, lowest vs highest vulnerability: 44 [84] months to 17 [28] months; P &lt; .001), with ML vulnerability followed by SES, HH, and HT being significantly associated with decreased survival (eg, ML for gliomas NOS: mean [SD] survival, lowest vs highest vulnerability: 42 [84] months vs 19 [35] months; P &lt; .001). Increased odds of advanced staging with non-Hodgkin lymphoma (OR, 1.21; 95% CI, 1.02-1.45) and retinoblastomas (OR, 1.31; 95% CI, 1.14-1.50) and decreased odds of surgery receipt for melanomas (OR, 0.79; 95% CI, 0.69-0.91) and rhabdomyosarcomas (OR, 0.90; 95% CI, 0.83-0.98) were associated with increasing overall social vulnerability.Conclusions and RelevanceIn this cohort study of patients with pediatric HNC, significant decreases in receipt of care and survival time were observed with increasing SDoH vulnerability.
ObjectivesStudies addressing social determinants of health (SDH) in head–neck melanomas (HNM) have only assessed incidence with increasing socioeconomic status. None have investigated a wider scope of SDH or their summed influence on affecting HNM prognosis and follow‐up care.MethodsThis retrospective cohort study analyzed 374,138 HNM in adults from 1975 to 2017 from the NCI‐Surveillance, Epidemiology, and End Results Program (NCI‐SEER) database. Utilizing the NCI‐SEER database, Social Vulnerability Index (SVI) scores were matched to county of residence upon diagnosis. Univariate linear regressions were performed on length of care (months of follow‐up/surveyed) and prognosis (months survival) across various SDH/SVI scores of socioeconomic status, minority and language status, household composition, housing and transportation, and their total composite.ResultsWith increasing overall SVI score, which indicates increasing social vulnerability, months of follow‐up showed significant decreases ranging from 0.04% to 27.63% compared with the lowest vulnerability groups, with the highest differences in nodular melanomas and the lowest with malignant melanomas in giant pigmented nevi. Similarly, months survival significant decreases ranged from 0.19% to 39.84% compared with the lowest SVI scores, with the highest difference in epithelioid cell melanomas and the lowest in amelanotic melanoma. Comprising this overall score trend, decreases with socioeconomic status, minority‐language status, household composition, and housing‐transportation contributed differentially per histology subtype.ConclusionsOur data highlight significant negative trends in HNM prognosis and care with higher total social vulnerability while showing which SDH‐themes quantifiably contribute more to these differences.Level of EvidenceIII Laryngoscope, 2023
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