IMPORTANCE Prolonged opioid use after surgery may be associated with opioid dependency and increased health care use. However, published studies have reported varying estimates of the magnitude of prolonged opioid use and risk factors associated with the transition of patients to longterm opioid use. OBJECTIVES To evaluate the rate and characteristics of patient-level risk factors associated with increased risk of prolonged use of opioids after surgery. DATA SOURCES For this systematic review and meta-analysis, a search of MEDLINE, Embase, and Google Scholar from inception to August 30, 2017, was performed, with an updated search performed on June 30, 2019. Key words may include opioid analgesics, general surgery, surgical procedures, persistent opioid use, and postoperative pain.STUDY SELECTION Of 7534 articles reviewed, 33 studies were included. Studies were included if they involved participants 18 years or older, evaluated opioid use 3 or more months after surgery, and reported the rate and adjusted risk factors associated with prolonged opioid use after surgery. DATA EXTRACTION AND SYNTHESISThe Meta-analysis of Observational Studies in Epidemiology (MOOSE) and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines were followed. Two reviewers independently assessed and extracted the relevant data. MAIN OUTCOMES AND MEASURESThe weighted pooled rate and odds ratios (ORs) of risk factors were calculated using the random-effects model. RESULTSThe 33 studies included 1 922 743 individuals, with 1 854 006 (96.4%) from the US. In studies with available sex and age information, participants were mostly female (1 031 399; 82.7%) and had a mean (SD) age of 59.3 (12.8) years. The pooled rate of prolonged opioid use after surgery was 6.7% (95% CI, 4.5%-9.8%) but decreased to 1.2% (95% CI, 0.4%-3.9%) in restricted analyses involving only opioid-naive participants at baseline. The risk factors with the strongest associations with prolonged opioid use included preoperative use of opioids (OR, 5.32; 95% CI, 2.94-9.64) or illicit cocaine (OR, 4.34; 95% CI,) and a preoperative diagnosis of back pain (OR, 2.05; 95% CI, 1.63-2.58). No significant differences were observed with various study-level factors, including a comparison of major vs minor surgical procedures (pooled rate: 7.0%; 95% CI, 4.9%-9.9% vs 11.1%; 95% CI, 6.0%-19.4%; P = .20). Across all of our analyses, there was substantial variability because of heterogeneity instead of sampling error. (continued) Key Points Question What are the rate and risk factors associated with prolonged use of opioid medications after surgery? Findings In this systematic review and meta-analysis of 33 observational studies including more than 1.9 million patients, 7% of patients continued to fill opioid prescriptions more than 3 months after surgery. Preoperative use of opioids, illicit cocaine use, and pain conditions before surgery had the strongest associations with prolonged opioid use after surgery. Meaning The findings suggest that an eval...
Background This study aims to investigate the association between social behaviors of increased‐risk donors (IRD) and recipient outcomes after heart transplantation. Methods The United Network for Organ Sharing (UNOS) database was queried to identify patients who received a heart transplant between 2004 and 2015. Patients were grouped based on donor's risk status (IRD vs standard risk donor [SRD]). Recipients of IRD were categorized based on donor social behaviors (SB), and recipient survival was assessed. Cox regression analysis was used to identify associations between SB of donors and recipient survival. Results Out of 22 333 heart transplantations performed during the study period, 2769 (12%) received an IRD graft with the following SB: Unprofessional tattoos or piercings (n = 1722) (63%), cocaine use (n = 916) (33%), heavy smoking (n = 437) (16%), and heavy alcohol abuse (n = 610) (22%). Viral screens detected 72(3%) hepatitis B virus (HBV) positive and 12 (0.4%) hepatitis C virus (HCV) positive at donation. There was no difference in recipient survival based on both donor risk and their social behaviors. Cox regression analysis found only donor HCV infection and non‐identical ABO mismatch to be associated with poor recipient survival among recipients of IR grafts. Conclusion Cardiac allografts from IRD, serologically negative for viruses, can safely be used. There is no association between social behaviors of IRD and recipient survival.
Objective: The North American Skull Base Society (NASBS) multidisciplinary annual conference hosts skull base researchers from across the globe. We hypothesized that the work presented at the NASBS annual conference would reveal diverse authorship teams in terms of specialty and geography. Methods: In this retrospective review, abstracts presented at the NASBS annual meeting and subsequently published in the Journal of Neurological Surgery Part B: Skull Base between 01/01/2011 and 12/31/2020 were collected. Variables extracted included year, type of presentation, and author names and affiliations. Statistical analyses were performed with SPSS V23.0 with p-values < 0.05 considered significant. Geographic heat maps were created to assess author distribution, and a network analysis was performed to display authorship collaboration between geographic regions. <b>Results:</b> Of 3,312 published abstracts, 731 (22.1%) had an author with an affiliation outside of the United States. Fifty-seven distinct countries were represented. 324 abstracts (9.8%) had authorship teams representing at least 2 different countries. The top five USA states by abstract representation were Pennsylvania, California, New York, Ohio, and Minnesota. A majority of authors reported neurosurgery affiliations (56.7% first authors, 53.2% last authors), closely followed by otolaryngology (39.1% first authors, 41.5% last authors). No solo authors and very few (3.3%) of the first authors reported a departmental affiliation outside of otolaryngology or neurosurgery. <b>Conclusions:</b> Authors from many countries disseminate their work through poster and oral presentations at the NASBS annual meeting. 10% of abstracts were the product of international collaboration. Most authors were affiliated with a neurosurgery or otolaryngology department.
Background: Minority populations are two to three times as likely to die of preventable cardiovascular events. Two main forces behind the challenge in managing hypertension among minority populations are disparities in health and healthcare. Aims: To identify the common health and healthcare disparities (HHD) among hypertensive patients who presented to a community medical center and propose a collaborative alliance for improvement. Methods: Internal medicine residents at the Newark Beth Israel Medical Center utilized a (P: Provider, I: Insurance, F: Food, E: Economic stability, N: Neighborhood, C: Culture and Language, E: Education, S: Social (PI-FENCES) model to identify health and health care disparities in hypertensive patients who presented to the ambulatory and inpatient settings over a 12-week-period. Demographic and baseline clinical characteristics were recorded. The distribution of each of the elements of PI-FENCES was documented and their association with respective demographics was determined. A protocol for usability study was designed based on preliminary data collected. Results: Between May 2019 and July 2019, a total of 86 hypertensive patients (mean ± SD age: 54 ± 12 years, BMI: 31± 8 kg/m 2 ) were identified. Seventy-one (83%) of them were African Americans. Of the patients identified, 51 (59%), presented to the ambulatory setting, 24 (28%) were seen in the in-patient setting and 11 (13%) were admitted to the Intensive care unit. According to the PI-FENCES model, distribution of HHD were as follows: n(%); P: 6 (6.9%), I: 40 (47%), F: 8(9.3%), E: 10 (11.6%), N: 1 (1.2%), C: 10 (14%), E: 26 (30.2%), S: 17 (19.7%). While 61 (71%) patients had at least 1 element of HHD, 9 (1.1%) had more than 2 elements of HHD. Associated cardiovascular conditions noted among admitted patients (n=35) were heart failure exacerbation (n=8) (22%) and cerebrovascular accident (n=4) (11%). Compared to patients with insurance, patients with no insurance were more likely to be admitted to the inpatient service or intensive care unit (Insurance: 31% vs. No insurance: 69%, p<0.0001). Based on the preliminary data, a Reducing ReAdmission Secondary to Hypertension (RRaSH) proposal will be implemented. RRaSH will focus on developing follow-up and referral plans for all uninsured hypertensive patients who present to the in-patient setting. The program will also encourage free health screening of families and friends of this uninsured population. Conclusion: About one out of every two patients who presented with systemic hypertension to a community medical center had no insurance. Compared to patients with insurance, patients with no insurance were more likely to be admitted to the inpatient service or intensive care unit. RRaSH will be a follow-up and referral plan to help reduce readmissions secondary to hypertension.
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