The Tightrope Walk

Anderson, Ida; Alger, Jessica

doi:10.1097/nor.0000000000000528

Cited by 6 publications

(4 citation statements)

References 14 publications

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“…These factors also predicted COU outcomes in the logistic model. This points towards the benefit of opioid stewardship to reduce the likelihood of patients becoming sustained high users 51–53. These trajectories are also important in validating opioid use.…”

Section: Discussionmentioning

confidence: 99%

“…This points towards the benefit of opioid stewardship to reduce the likelihood of patients becoming sustained high users. [51][52][53] These trajectories are also important in validating opioid use. Since opioid use was defined by filling a prescription and not by actual consumption, the analysis was subject to spurious error in defining COU.…”

Section: Discussionmentioning

confidence: 99%

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Opioid Use Patterns in a Statewide Adult Medicaid Population Undergoing Elective Lumbar Spine Surgery

Reitman

Ward

Taber

et al. 2022

Spine

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Study Design. Retrospective administrative database review.Objective. Analyze patterns of opioid use in patients undergoing lumbar surgery and determine associated risk factors in a Medicaid population. Summary of Background Data. Opioid use in patients undergoing surgery for degenerative lumbar spine conditions is prevalent and impacts outcomes. There is limited information defining the scope of this problem in Medicaid patients. Materials and Methods. Longitudinal cohort study of adult South Carolina (SC) Medicaid patients undergoing lumbar surgery from 2014 to 2017. All patients had continuous SC Medicaid coverage for 15 consecutive months, including six months before and nine months following surgery. The primary outcome was a longitudinal assessment of postoperative opioid use to determine trajectories and group-based membership using latent modeling. Univariate and multivariable modeling was conducted to assess risk factors for group-based trajectory modeling and chronic opioid use (COU). Results. A total of 1455 surgeries met inclusion criteria. Groupbased trajectory model demonstrated patients fit into five groups; very low use (23.4%), rapid wean following surgery (18.8%), increasing use following surgery (12.9%), slow wean following surgery (12.6%) and sustained high use (32.2%). Variables predicting membership in high opioid use included preoperative opioid use, younger age, longer length of stay, concomitant medications, and readmissions. More than three quarter of patients were deemed COUs (76.4%). On bivariate analysis, patients with degenerative disk disease were more likely to be COUs (24.8% vs. 18.6%; P = 0.0168), more likely to take opioids before surgery (88.5% vs. 61.9%; P < 0.001) and received higher amounts of opioids during the 30 days following surgery (mean morphine milligram equivalents 59.6 vs. 25.1; P < 0.001). Conclusions. Most SC Medicaid patients undergoing lumbar elective lumbar spine surgery were using opioids preoperatively and continued long-term use postoperatively at a higher rate than previously reported databases. Preoperative and perioperative intake, degenerative disk disease, multiple prescribers, depression, and concomitant medications were significant risk factors.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Opioid Use Patterns in a Statewide Adult Medicaid Population Undergoing Elective Lumbar Spine Surgery

Reitman

Ward

Taber

et al. 2022

Spine

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“…The Joint Commission standards require that hospitals provide nurses with resources regarding pain management, including the safe use of opioids, nonopioids, and nonpharmacological pain management options (The Joint Commission, 2017). Nurses have ethical and moral responsibilities to relieve the pain and suffering of patients while mitigating the risk for developing opioid dependence (American Nurses Association, 2018; Anderson & Alger, 2019). Patients' right to autonomy and dignity supports the need for education on the risks, side effects, and safety profile of their pain management treatment options; especially, the need to balance pain control with safety when using opioids.…”

Section: Ethical Considerationsmentioning

confidence: 99%

Acute Perioperative Pain Management of the Orthopaedic Patient

McNaughton,

Quinlan-Colwell,

Lyons

et al. 2024

Orthopaedic Nursing

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Orthopaedic surgery often results in pain, with less than half of patients reporting adequate relief. Unrelieved acute pain occurring after surgery increases the risk of negative sequelae, including delayed healing, increased morbidity, pulmonary complications, limited rehabilitation participation, anxiety, depression, increased length of stay, prolonged duration of opioid use, and the development of chronic pain. Interventions that are individualized, evidence-informed, and applied within an ethical framework improve healthcare delivery for patients, clinicians, and healthcare organizations. Recommendations for using the principles of effective pain management from preoperative assessment through discharge are detailed, including recommendations for addressing barriers and challenges in applying these principles into clinical practice.

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“…It is the position of NAON and ASPMN that nurses have an ethical imperative to optimally facilitate the relief of acute postoperative pain and suffering among orthopaedic patients while mitigating untoward risks (American Nurses Association, 2018; Anderson & Alger, 2019). The perioperative period for the orthopaedic surgical patient provides opportunities and challenges for nursing.…”

Section: Position With Guiding Principlesmentioning

confidence: 99%

Acute Perioperative Pain Management Among Adult Patients Undergoing Orthopaedic Surgery

Arkin

Lyons

McNaughton

et al. 2022

Orthopaedic Nursing

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Patients undergoing elective orthopaedic surgery may experience pain that is acute, chronic, or a combination of the two, with less than half of all surgical patients reporting adequate pain relief (Chou et al., 2016). Unrelieved acute pain can result in many adverse sequelae including delayed healing, increased morbidity, pulmonary complications, limited rehabilitation participation, anxiety, depression, increased length of stay, prolonged duration of opioid use, and the development of chronic pain (Glare et al., 2019;Quinlan-Colwell, 2020).

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The Tightrope Walk

Cited by 6 publications

References 14 publications

Opioid Use Patterns in a Statewide Adult Medicaid Population Undergoing Elective Lumbar Spine Surgery

Opioid Use Patterns in a Statewide Adult Medicaid Population Undergoing Elective Lumbar Spine Surgery

Acute Perioperative Pain Management of the Orthopaedic Patient

Acute Perioperative Pain Management Among Adult Patients Undergoing Orthopaedic Surgery

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