Background Effective pain control is crucial to postoperative recovery and is affected by biopsychosocial factors. This study aimed to evaluate how non‐English primary language, gender, and marital status may influence pain, length of stay, and mortality after general surgery. Methods Consecutive general surgical admissions over a two‐year period to two tertiary hospitals were included. Multivariable logistic regression analyses were conducted to evaluate the relationship between non‐English primary language, gender, and marital status, and pain scores, length of stay, and in‐hospital mortality. Explanatory variables that were controlled for in these analyses included age, birth country, whether a religion was specified, socioeconomic percentile, Charlson comorbidity index, and time of admission. Results A total of 12 846 general surgery patients were included. When controlling for the aforementioned variables, including having a specified religion and being born overseas, having a non‐English primary language was significantly independently associated with lower pain scores (odds ratio 0.61, 95% CI 0.52–0.71, P < 0.001). Female gender was independently associated with an increased likelihood of higher pain scores (odds ratio 1.09, 95% CI 1.01–1.18, P = 0.024) and a lower likelihood of prolonged length of stay (odds ratio 0.88, 95% CI 0. 80–0.95, P = 0.002). None of the evaluated variables had a statistically significant association with in‐hospital mortality. Conclusions This study is the first to characterize an association between general surgery patients with a non‐English primary language and lower levels of postoperative pain. It was also found that female gender was associated with higher postoperative pain but lower length of hospital stay.
<b><i>Introduction:</i></b> Penicillin allergy labels are common. However, many penicillin allergy labels have been applied incorrectly and in fact represent penicillin intolerance. Patients with penicillin intolerance can receive penicillin antibiotics. The effect of penicillin intolerance labels on prescribing practices is uncertain. <b><i>Methods:</i></b> This multicenter retrospective cohort study included consecutive general medicine patients admitted to two tertiary hospitals over a 12-month period. Electronic medical records were reviewed for allergy and prescribing practices. Instances of penicillin prescription to patients with previously labeled penicillin allergies underwent case note review. <b><i>Results:</i></b> There were 12,134 individual hospital admissions included in the study. The number of admissions with a previous penicillin allergy label was 1,312 (10.8%) and with a penicillin intolerance label was 60 (0.5%). Penicillin allergy labels were associated with increased likelihood of being prescribed vancomycin (odds ratio 1.42, 95% confidence interval 1.16–1.75, <i>p</i> = 0.001) and moxifloxacin (odds ratio 20.0, 95% confidence interval 13.4–29.9, <i>p</i> < 0.001). Penicillin intolerance was not associated with increased likelihood of receiving these antibiotics. There were 75 admissions during which an individual with a penicillin allergy label was prescribed one of the specified penicillins and only one adverse reaction in this group. These cases included eight deliberate challenges and 15 cases in which allergy history clarification was sufficient to delabel the allergy. <b><i>Conclusions:</i></b> This study supports that prescribing practices differ between patients with penicillin allergy labels and intolerance labels. Penicillin challenges may be undertaken safely in the inpatient setting. Further studies are required to investigate how best to interrogate penicillin allergy labels in this cohort.
Intravenous immunoglobulin (IVIg), which is used to treat multiple neurological conditions, may be associated with serious adverse reactions. The individual neurological disease characteristics associated with adverse reactions, along with strategies to prevent and treat adverse reactions, are uncertain. A systematic review was conducted of the databases PubMed, Embase, and Cochrane Library to summarise studies that report adverse reactions of IVIg therapy in patients with neurological disease. There were 65 studies included in the review. The reported rates of adverse reactions vary widely, but the best evidence suggests rates between 25 and 34% per patient. Common adverse reactions include headache and laboratory abnormalities. Less common but serious adverse reactions included thromboembolic complications and anaphylaxis. Overall, there is a lack of high-quality comparative data to definitively determine if any specific neurological indications are associated with a higher risk of adverse reactions. However, individual neurological disease characteristics possibly associated with an increased likelihood of adverse reactions include limited mobility (as in certain neuromuscular conditions), paraproteinaemia (as in certain peripheral neuropathies), and cardiomyopathy (as in certain myopathies). There is limited evidence to support the effectiveness of prevention and treatment strategies, which may include modification to dose, reduced infusion rate, and premedication. Further studies regarding methods to prevent and treat IVIg-ARs in neurology patients are required.
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