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Murphy J, Pak S, Shteynman L, Winkeler I, Jin Z, Kaczocha M, Bergese SD. Mechanisms and Preventative Strategies for Persistent Pain following Knee and Hip Joint Replacement Surgery: A Narrative Review. Int J Mol Sci 2024; 25:4722. [PMID: 38731944 PMCID: PMC11083264 DOI: 10.3390/ijms25094722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/19/2024] [Accepted: 04/21/2024] [Indexed: 05/13/2024] Open
Abstract
Chronic postsurgical pain (CPSP) following total knee arthroplasty (TKA) and total hip arthroplasty (THA) is a prevalent complication of joint replacement surgery which has the potential to decrease patient satisfaction, increase financial burden, and lead to long-term disability. The identification of risk factors for CPSP following TKA and THA is challenging but essential for targeted preventative therapy. Recent meta-analyses and individual studies highlight associations between elevated state anxiety, depression scores, preoperative pain, diabetes, sleep disturbances, and various other factors with an increased risk of CPSP, with differences observed in prevalence between TKA and THA. While the etiology of CPSP is not fully understood, several factors such as chronic inflammation and preoperative central sensitization have been identified. Other potential mechanisms include genetic factors (e.g., catechol-O-methyltransferase (COMT) and potassium inwardly rectifying channel subfamily J member 6 (KCNJ6) genes), lipid markers, and psychological risk factors (anxiety and depression). With regards to therapeutics and prevention, multimodal pharmacological analgesia, emphasizing nonopioid analgesics like acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs), has gained prominence over epidural analgesia. Nerve blocks and local infiltrative anesthesia have shown mixed results in preventing CPSP. Ketamine, an N-methyl-D-aspartate (NMDA)-receptor antagonist, exhibits antihyperalgesic properties, but its efficacy in reducing CPSP is inconclusive. Lidocaine, an amide-type local anesthetic, shows tentative positive effects on CPSP. Selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) have mixed results, while gabapentinoids, like gabapentin and pregabalin, present hopeful data but require further research, especially in the context of TKA and THA, to justify their use for CPSP prevention.
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Affiliation(s)
- Jasper Murphy
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA; (J.M.); (S.P.); (L.S.); (I.W.)
| | - Sery Pak
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA; (J.M.); (S.P.); (L.S.); (I.W.)
| | - Lana Shteynman
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA; (J.M.); (S.P.); (L.S.); (I.W.)
| | - Ian Winkeler
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA; (J.M.); (S.P.); (L.S.); (I.W.)
| | - Zhaosheng Jin
- Department of Anesthesiology, Stony Brook University, Stony Brook, NY 11794, USA; (M.K.); (S.D.B.)
| | - Martin Kaczocha
- Department of Anesthesiology, Stony Brook University, Stony Brook, NY 11794, USA; (M.K.); (S.D.B.)
| | - Sergio D. Bergese
- Department of Anesthesiology, Stony Brook University, Stony Brook, NY 11794, USA; (M.K.); (S.D.B.)
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Tidadini F, Trilling B, Quesada JL, Abba J, Foote A, Faucheron JL, Arvieux C. Impact of Body Mass Index on Postoperative Pain and Opioid Administration After Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC). J Gastrointest Cancer 2024; 55:297-306. [PMID: 37458969 DOI: 10.1007/s12029-023-00957-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2023] [Indexed: 05/16/2024]
Abstract
PURPOSE Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a new surgical technique, developed for the treatment of peritoneal carcinomatosis (PC). In this retrospective observational study we assessed the impact of body mass index (BMI) on postoperative pain and opioid consumption. METHODS We analyzed pain scores after 100 PIPAC procedures using either oxaliplatin or doxorubicin-cisplatin performed in 49 patients with PC between July 2016 and September 2020. The patients were divided into 3 groups (BMI <18.5, 18.5 ≥ BMI < 25, BMI≥25). Pain was self-rated on a visual analogue scale (VAS) from 0 to 10. RESULTS Univariate logistic regression analysis identified oxaliplatin and PCI score to be associated with moderate to severe pain (VAS 4-10 at 8 am D1) after adjustment on BMI (OR [95% CI]; 3.26[1.00 - 10.65] p=0.050) and (OR [95% CI]; 1.09[1.01 - 1.17] p=0.019). The level of pain appeared significantly different between the treatment groups (median 2.5[0; 5] vs 0[0; 2.5] p=0.0017) irrespective of BMI (p =0.705 and p=0.118). Multivariate logistic regression analysis identified moderate to severe pain and synchronous PC to be associated with greater use of opioids (OR [95% CI]: 3.91 [1.24 - 12.32]) and (OR [95% CI]: 5.16 [1.71 - 15.58]; respectively. Opioids were administered after 45 procedures (45%) and was comparable between the treatment groups. Opioid administration and length-of-stay were similar among BMI bands. CONCLUSION BMI is not related to postoperative pain or opioid use, howevermoderate to severe pain and synchronous PC are factors associated with requiring opioids.
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Affiliation(s)
- Fatah Tidadini
- Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France
- Lyon Center for lnnovation in Cancer, Lyon 1 University, Lyon, EA, 3738, France
| | - Bertrand Trilling
- Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France
- Univ. Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, TIMC, 3800 Grenoble, La Tronche, France
| | - Jean-Louis Quesada
- Clinical Pharmacology Unit, INSERM CIC1406, Grenoble Alpes University Hospital, Grenoble, France
| | - Julio Abba
- Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France
| | - Alison Foote
- Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France
| | - Jean-Luc Faucheron
- Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France
- Univ. Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, TIMC, 3800 Grenoble, La Tronche, France
| | - Catherine Arvieux
- Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France.
- Lyon Center for lnnovation in Cancer, Lyon 1 University, Lyon, EA, 3738, France.
- Department of Surgery, CHU Grenoble-Alpes, CS 10232, 38043, Grenoble Cedex 09, France.
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Teimouri M, Motififard M, Lalehzar SS, Shahsavan M, Khayam T, Taravati AM, Sadeghian A. Persistent pain following total knee arthroplasty: The role of underlying diseases. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2023; 28:57. [PMID: 37496648 PMCID: PMC10366980 DOI: 10.4103/jrms.jrms_190_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 05/30/2023] [Accepted: 06/05/2023] [Indexed: 07/28/2023]
Abstract
Background With increasing age and joint-destructive diseases, the need for novel surgeries such as total knee arthroplasty (TKA) has increased. Complications such as pain exacerbation and persistent pain after surgery may occur which increases rehabilitation programs. Factors such as body mass index (BMI), psychiatric disorders, spine diseases, and comorbidities diseases can affect outcomes. Our study was conducted to evaluate the effect of BMI, psychiatric disorders, spine diseases, and underlying diseases on persistent and annoying pain after TKA. Materials and Methods This is a case-control study that was conducted on patients who underwent TKA in Kashani Hospital in Isfahan City in 2020-2022. Demographic data of patients including age and BMI, diabetes mellitus (DM), history of psychiatric disorders, spine disorders such as spondylolisthesis or disc herniation, and other underlying diseases were obtained. Patients were assigned to case or control groups based on pain complaints after surgery. All patients were evaluated 6 months after the initial surgery. After collecting the study data, they were entered into SPSS software (version 25, IBM Corporation, Armonk, NY, USA) and analyzed. Results We enrolled 35 patients in the case group and 39 patients in the control group between June 2020 and September 2022, based on the severity of pain measured using a Visual Analog Scale score. Our results show that BMI and DM had a meaningful relationship with pain after surgery (P ≤ 0.01). Other factors did not show a significant difference between groups. Conclusion Underlying diseases, psychiatric diseases, and spine disorders did not significantly affect the pain after TKA. Patients with DM and higher BMI experienced more persistent pain after TKA.
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Affiliation(s)
- Mehdi Teimouri
- Department of Orthopedic Surgery, School of Medicine, KashaniUniversity Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehdi Motififard
- Department of Orthopedic Surgery, School of Medicine, KashaniUniversity Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sahar Sadat Lalehzar
- Department of Orthopedic Surgery, School of Medicine, KashaniUniversity Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Shahsavan
- Department of Orthopedic Surgery, School of Medicine, KashaniUniversity Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Tala Khayam
- Department of Orthopedic Surgery, School of Medicine, Al-Zahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amir Mohammad Taravati
- Department of Orthopedic Surgery, School of Medicine, Al-Zahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amirhossein Sadeghian
- Department of Orthopedic Surgery, School of Medicine, Zabol University of Medical Sciences, Zabol, Sistan and Baluchestan Province, Iran
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Zhang B, Rao S, Mekkawy KL, Rahman R, Sarfraz A, Hollifield L, Runge N, Oni JK. Risk factors for pain after total hip arthroplasty: a systematic review. ARTHROPLASTY 2023; 5:19. [PMID: 37009894 PMCID: PMC10069042 DOI: 10.1186/s42836-023-00172-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 02/15/2023] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND Approximately 23% of patients develop hip pain after total hip arthroplasty (THA). In this systematic review, we aimed to identify risk factors associated with postoperative pain after THA to optimize preoperative surgical planning. METHODS Six literature databases were searched for articles published from January 1995 to August 2020. Controlled trials and observational studies that reported measurements of postoperative pain with assessments of preoperative modifiable and non-modifiable risk factors were included. Three researchers performed a literature review independently. RESULTS Fifty-four studies were included in the study for analysis. The most consistent association between worse pain outcomes and the female sex is poor preoperative pain or function, and more severe medical or psychiatric comorbidities. The correlation was less strong between worse pain outcomes and preoperative high body mass index value, low radiographic grade arthritis, and low socioeconomic status. A weak correlation was found between age and worse pain outcomes. CONCLUSIONS Preoperative risk factors that were consistently predictive of greater/server postoperative pain after THA were identified, despite the varying quality of studies that prohibited the arrival of concrete conclusions. Modifiable factors should be optimized preoperatively, whereas non-modifiable factors may be valuable to patient education, shared decision-making, and individualized pain management.
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Affiliation(s)
- Bo Zhang
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 North Caroline Street, Baltimore, MD, 21287, USA
| | - Sandesh Rao
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 North Caroline Street, Baltimore, MD, 21287, USA
| | - Kevin L Mekkawy
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 North Caroline Street, Baltimore, MD, 21287, USA.
| | - Rafa Rahman
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 North Caroline Street, Baltimore, MD, 21287, USA
| | - Anzar Sarfraz
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 North Caroline Street, Baltimore, MD, 21287, USA
| | - Lauren Hollifield
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 North Caroline Street, Baltimore, MD, 21287, USA
| | - Nick Runge
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 North Caroline Street, Baltimore, MD, 21287, USA
| | - Julius K Oni
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 North Caroline Street, Baltimore, MD, 21287, USA
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Zhou K, Li Q, Hu X, Zhu H, Liu J. The effect of preoperative HbA1c on chronic postsurgical pain in diabetic patients undergoing video-assisted thoracic surgery - A retrospective cohort study. J Clin Anesth 2022; 83:110988. [PMID: 36332364 DOI: 10.1016/j.jclinane.2022.110988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Kang Zhou
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, China
| | - Qing Li
- School of Nursing, Xuzhou Medical University, China
| | - Xiaoyi Hu
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, China
| | - He Zhu
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, China
| | - Jindong Liu
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, China; Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, China; Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou Medical University, China; NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, China.
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McVey LC, Kane N, Murray H, Meek RMD, Ahmed SF. Elective hip arthroplasty rates and related complications in people with diabetes mellitus. Hip Int 2022; 32:717-723. [PMID: 33334203 PMCID: PMC9726745 DOI: 10.1177/1120700020981573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Diabetes mellitus (DM), poor glycaemic control and raised body mass index (BMI) have been associated with postoperative complications in arthroplasty, although the relative importance of these factors is unclear. We describe the prevalence of DM in elective hip arthroplasty in a UK centre, and evaluate the impact of these factors. METHODS We analysed retrospective data for DM patients undergoing arthroplasty over a 6-year period and compared with non-diabetic matched controls (1 DM patient: 5 controls). DM was present in 5.7% of hip arthroplasty patients (82/1443). RESULTS Postoperative complications occurred in 12.2% of DM patients versus 12.9% of controls (p = 1.000); surgical complications were present in 6.1% of those with DM and 2.4% of controls (p = 0.087), while medical complications occurred in 8.5% of DM patients versus 10.7% of controls (p = 0.692). Complications developed in 23.1% of DM patients with poor glycaemic control (HbA1c > 53 mmol/mol) versus 9.8% with good control (p = 0.169). In DM patients and controls combined, complications occurred in 16.3% of obese patients versus 10.0% of non-obese patients (p = 0.043). In the DM cohort, 13.7% of overweight patients had complications versus 0% with a normal or low BMI (p = 0.587). CONCLUSIONS DM rates were lower than expected, and glycaemic control was good. Overall complication rates were unrelated to the presence of DM or to glycaemic control, although surgical complications were observed more frequently in those with DM and poor glycaemic control was uncommon within our cohort. Complications were more frequent in those with a higher BMI. Whether some patients with DM but without an increased risk of complications are currently being excluded from surgery requires exploration.
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Affiliation(s)
- Lindsey C McVey
- Developmental Endocrinology Research Group, School of Medicine, University of Glasgow, Glasgow, UK
| | - Nicholas Kane
- Department of Trauma and Orthopaedics, Queen Elizabeth University Hospital, Glasgow, UK
| | - Helen Murray
- Department of Trauma and Orthopaedics, Queen Elizabeth University Hospital, Glasgow, UK
| | - RM Dominic Meek
- Department of Trauma and Orthopaedics, Queen Elizabeth University Hospital, Glasgow, UK
| | - S Faisal Ahmed
- Developmental Endocrinology Research Group, School of Medicine, University of Glasgow, Glasgow, UK,S Faisal Ahmed, Developmental Endocrinology Research Group, School of Medicine, Dentistry and Nursing, University of Glasgow, Royal Hospital for Children, 1345 Govan Road, Glasgow, G51 4TF, UK.
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Incidence, risk factors, prevention and treatment of postmastectomy pain syndrome in breast cancer: A multicenter study. Int J Surg 2022; 106:106937. [PMID: 36152923 DOI: 10.1016/j.ijsu.2022.106937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/08/2022] [Accepted: 09/09/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Postmastectomy pain syndrome (PMPS) is a common postoperative condition after breast cancer surgery. PURPOSE The aim of this study was to investigate the incidence rate and risk factors of PMPS, and to propose prevention and treatment methods. METHODS The study included 1790 postoperative breast cancer patients from three hospitals from 2017 to 2021, of which 302 (13.0%) patients with PMPS were included in the study. RESULTS Age, breast surgery type, axillary surgery type and radiotherapy are the risk factors of PMPS. Age, radiotherapy and chemotherapy affect the pain degree of PMPS during movement. CONCLUSIONS For breast cancer patients with high risk factors, pain should be actively prevented during perioperative period. Oral pharmacological agents, multidisciplinary combination therapy, local anesthetics and regional anesthesia are the most common treatment of PMPS.
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Tidadini F, Abba J, Quesada JL, Villeneuve L, Foote A, Baudrant M, Bonne A, Glehen O, Trilling B, Faucheron JL, Arvieux C. Assessment of postoperative pain after pressurized intraperitoneal aerosol chemotherapy (PIPAC) in the treatment of peritoneal metastasis. Int J Colorectal Dis 2022; 37:1709-1717. [PMID: 35639123 DOI: 10.1007/s00384-022-04182-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/07/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a new surgical technique, for the treatment of initially unresectable peritoneal metastasis (PM). Our objective was to assess postoperative pain and morbidity. METHODS Between July 2016 and September 2020, data from 100 consecutive PIPAC procedures with oxaliplatin (PIPAC Ox) or doxorubicin-cisplatin (PIPAC C/D) in 49 patients with PM (all etiologies) were analyzed. Pain was self-assessed using a visual analog scale (VAS) of 0-10. RESULTS The median PIPAC procedures per patient were 2 [1-3]. Patients indicated greatest pain at 4 pm on the day of the procedure (D0) and on postoperative D1 at 8 am and 4 pm. Postprocedural moderate-to-severe pain (VAS 4-10) was more frequent with PIPAC Ox than with PIPAC C/D, respectively 14 (36.8%) vs 7 (13.5%); p = 0.010. Hospitalization was longer for patients with moderate-to-severe pain than for others (median 4 days [3-7] vs 3 days [2-4], p = 0.004). Multivariate analysis identified oxaliplatin as a factor associated with greater pain (OR [95% CI], 2.95 [1.10-7.89]. Opiate administration was similar after PIPAC Ox and PIPAC C/D procedures, p = 0.477. CONCLUSION PIPAC was well-tolerated, and pain was well-controlled in the majority of patients. Pain was greatest at 4 pm on D0 and 8 am and 4 pm on D1. PIPAC Ox is associated with greater pain than PIPAC C/D, independently of opiate treatment. Moderate-to-severe pain was associated with longer hospital stays.
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Affiliation(s)
- Fatah Tidadini
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France.,Lyon Center for Innovation in Cancer, EA 3738, Lyon 1 University, Lyon, France
| | - Julio Abba
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France
| | - Jean-Louis Quesada
- Clinical Pharmacology Unit, INSERM CIC1406, Grenoble Alpes University Hospital, Grenoble, France
| | - Laurent Villeneuve
- Lyon Center for Innovation in Cancer, EA 3738, Lyon 1 University, Lyon, France
| | - Alison Foote
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France
| | - Magalie Baudrant
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France
| | - Aline Bonne
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France
| | - Olivier Glehen
- Lyon Center for Innovation in Cancer, EA 3738, Lyon 1 University, Lyon, France
| | - Bertrand Trilling
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France.,UMR 5525, CNRS, TIMC-IMAG, University Grenoble Alpes, 38000, Grenoble, France
| | - Jean-Luc Faucheron
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France.,UMR 5525, CNRS, TIMC-IMAG, University Grenoble Alpes, 38000, Grenoble, France
| | - Catherine Arvieux
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France. .,Lyon Center for Innovation in Cancer, EA 3738, Lyon 1 University, Lyon, France.
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Hunt D, Zhang T, Koenig S, Aneizi A, Perraut G, Shasti K, Wahl AJ, Meredith SJ, Henn RF. Predictors of PROMIS Physical Function at 2 Years following Knee Surgery. J Knee Surg 2022; 35:521-528. [PMID: 32898902 DOI: 10.1055/s-0040-1716360] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The purpose of this study was to evaluate Patient-Reported Outcomes Measurement Information System physical function (PROMIS PF) 2 years following knee surgery, and identify preoperative factors associated with postoperative PROMIS PF. Three hundred and sixty-five patients, age 17 years and older, undergoing knee surgery at one institution were studied. Patients completed multiple questionnaires prior to surgery and again 2 years postoperatively including PROMIS PF, International Knee Documentation Committee (IKDC), joint and body numeric pain scales (NPS), Tegner's activity scale (TAS), and Marx's activity rating scale (MARS). Mean PROMIS PF improved from 41.4 to 50.9 at 2 years postoperatively (p < 0.001) and was strongly correlated with 2-year IKDC scores. Older age, female gender, non-Hispanic ethnicity, unemployment, lower income, government insurance, smoking, preoperative opioid use, having a legal claim, comorbidities, previous surgeries, higher body mass index (BMI), and knee arthroplasty were associated with worse 2-year PROMIS PF. Multivariable analysis confirmed that lower BMI, less NPS body pain, and higher MARS were independent predictors of greater 2-year PROMIS PF and better improvement in PROMIS PF. In this large, broad cohort of knee surgery patients, multiple preoperative factors were associated with PROMIS PF 2 years postoperatively. PROMIS PF scores improved significantly, but worse 2 year PROMIS PF scores and less improvement from baseline were independently predicted by higher BMI, greater NPS body pain, and lower MARS activity level. PROMIS PF can be implemented as an efficient means to assess outcomes after knee surgery.
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Affiliation(s)
- Darius Hunt
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Tina Zhang
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Scott Koenig
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Ali Aneizi
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Gregory Perraut
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Keyan Shasti
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Alexander J Wahl
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Sean J Meredith
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - R Frank Henn
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
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Hanley C, Ladha KS, Clarke HA, Cuthbertson BC, Wijeysundera DN. Association of postoperative complications with persistent post-surgical pain: a multicentre prospective cohort study. Br J Anaesth 2021; 128:311-320. [PMID: 34872718 DOI: 10.1016/j.bja.2021.10.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 10/14/2021] [Accepted: 10/19/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Persistent post-surgical pain is an important and under-recognised problem that is difficult to treat. Postoperative complications have been identified as possible risk factors for persistent post-surgical pain. We conducted a secondary analysis of the Measurement of Exercise Tolerance before Surgery (METS) cohort study to characterise the association of major postoperative complications with post-surgical pain at 30 days and 1 yr after major surgery. METHODS The analysis included 1313 participants (≥40 yr old) who had inpatient noncardiac surgery and survived for 1 yr. The co-primary outcomes were 30-day post-surgical pain and 1-yr post-surgical pain. Post-surgical pain was defined as pain or discomfort that was of moderate or severe intensity (EuroQoL-5D [EQ-5D] instrument) and unimproved compared with preoperative pain or discomfort. The principal exposure was major in-hospital complications (moderate or severe by modified Clavien-Dindo criteria). Multivariable logistic regression modelling was used to characterise the adjusted association of major complications with outcomes. RESULTS Of the cohort, 12% (n=163) experienced major complications, 51% (n=674) reported 30-day post-surgical pain, and 42% (n=545) reported 1-yr post-surgical pain. Major complications were associated with 30-day post-surgical pain (adjusted odds ratio [aOR]=1.54; 95% confidence interval [CI], 1.05-2.23) and possibly 1-yr post-surgical pain (aOR=1.42; 95% CI, 0.98-2.06). When analyses were repeated after multiple imputation of missing covariate and outcome data, complications were associated with both 30-day and 1-yr post-surgical pain. CONCLUSIONS Patients who developed major complications were more likely to report pain at 30 days and possibly 1 yr after surgery. Research is necessary to validate these findings and delineate underlying mechanisms.
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Affiliation(s)
- Ciara Hanley
- Department of Anesthesia, St. Michael's Hospital, Toronto, ON, Canada; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada; Department of Anaesthesia, University Hospital Galway, Galway, Ireland
| | - Karim S Ladha
- Department of Anesthesia, St. Michael's Hospital, Toronto, ON, Canada; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Institute of Health Policy, University of Toronto, Toronto, ON, Canada
| | - Hance A Clarke
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada; Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada
| | - Brian C Cuthbertson
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, University of Toronto, Toronto, ON, Canada; Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Duminda N Wijeysundera
- Department of Anesthesia, St. Michael's Hospital, Toronto, ON, Canada; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Institute of Health Policy, University of Toronto, Toronto, ON, Canada.
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Preoperative and Postoperative Opioid Prescription Rates in the Total Hip Replacement Surgical Patient. Orthop Nurs 2021; 40:366-374. [PMID: 34851880 DOI: 10.1097/nor.0000000000000808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The United States is facing an opioid epidemic that has only worsened with the COVID-19 pandemic. There is little evidence regarding patterns of opioid use among patients with total hip replacement (THR). Although the Centers for Disease Control and Prevention has put forward guidelines for prescribing opioids, it does not include guidance specifically for THR patients suffering from presurgical and postsurgical pain. The purpose of this study was to (1) compare presurgical and postsurgical opioid rates, (2) compare presurgical and postsurgical morphine milligram equivalents (MME), and (3) determine whether having a presurgical opioid prescription predicts the receipt of postsurgical opioid prescriptions among patients undergoing THR surgery. Retrospective cohort analysis of 4,405 patients undergoing THR at a major academic medical center in the United States from April 30, 2015, to April 30, 2018, was done. Patient characteristics, opioid rates, and average MME/day/person were described. Logistic regression was used to determine whether presurgical opioid prescription and opioid risk level predicted postsurgical opioid prescribing. Median age was 64 years (range = 18-85 years); patients were primarily Caucasian/White (78.8%) and female (54.7%). Opioid prescription rates in this sample for the 12-month presurgical and postsurgical periods were 66.1% and 95.6%, respectively. Oxycodone was the most common opioid prescribed in both periods. Among those prescribed an opioid, moderate/high risk for overdose and/or death was 6.3% presurgery and 19.8% postsurgery. Patients with a comorbidity were two times more likely to receive an opioid prescription in the postsurgical period. The median average MME/day/person was 26.5 (range = 0.3-180.0) for patients with an opioid prescribed during the presurgery period and 40.4 (range = 1.5-270.0) during the postsurgery period. Opioid use, regardless of strength, in the presurgical period as well as having one or more comorbidities predicted opioid use in the postsurgical period.
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12
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Associated risk factors of postoperative pain after glaucoma surgery: a prospective study. Int Ophthalmol 2021; 42:829-840. [PMID: 34674085 DOI: 10.1007/s10792-021-02048-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 09/22/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE This study aimed to determine degree of postoperative pain and the incidence of serious postoperative pain after glaucoma surgery and further to identify the associated risk factors. METHODS A total of 194 consecutive patients who were diagnosed with glaucoma and underwent glaucoma surgery were enrolled in this study. The intensity of postoperative pain was evaluated using numerical rating scale (NRS) within 24 h after surgery; NRS ≥ 5 was considered as clinically significant postoperative pain. Risk factors associated with the development of postoperative pain were analyzed by multivariate logistic regression analysis. RESULTS Clinically significant postoperative pain was experienced at any time after glaucoma surgery in 41.75% of the patients, which peak at 2 h. 27.8% of the patients requested analgesic medication within 24 h after surgery. According to multivariate logistic regression analysis, preoperative anxiety (OR = 4.13 [1.29-13.2], p = 0.017), cyclophotocoagulation (OR = 30.9 [3.47-375.1], p = 0.002), and phacotrabeculectomy combined with or without intraocular lens implantation (OR = 30.0 [2.69-335.6], p = 0.006) were associated with increased clinically significant postoperative pain. Interestingly, patients with diabetes and/or hypertension were associated with less postoperative pain after glaucoma surgery (OR = 0.23 [0.08-0.64], p = 0.005). CONCLUSION Patients undergoing glaucoma surgery tend to experience postoperative pain in the early postoperative period. Anxiety level and surgery types of cyclophotocoagulation and phacotrabeculectomy are risk factors for postoperative pain. Patients with diabetes and/or hypertension are less likely to develop postoperative pain.
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Perets I, Chaharbakhshi EO, Barkay G, Mu BH, Lall AC, Domb BG. Diabetes Mellitus Is Not a Negative Prognostic Factor for Patients Undergoing Hip Arthroscopy. Orthopedics 2021; 44:241-248. [PMID: 34292812 DOI: 10.3928/01477447-20210621-02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Diabetes mellitus (DM) has been associated with inferior clinical outcomes and comorbidities in general. The authors sought to compare the outcomes of hip arthroscopy at minimum 2-year follow-up for patients with DM with those of patients without DM. Data were prospectively collected and retrospectively reviewed for patients who underwent hip arthroscopy between February 2008 and December 2014. The inclusion criteria were patients with DM who underwent hip arthroscopy for the treatment of femoroacetabular impingement and labral tears and had preoperative patient- reported outcomes. The exclusion criteria were preoperative Tönnis grade greater than 1, previous ipsilateral hip surgery, and/or previous conditions. All patients with DM were matched in a 1:2 ratio to control patients without DM. The matching criteria were age at surgery, sex, body mass index, workers' compensation, capsular treatment, and acetabular Outerbridge grade 0 or 1 vs 2, 3, or 4. Of 29 eligible patients with DM, 26 (89.7%) had minimum 2-year follow-up. Twenty-six patients with DM were matched and compared with 52 patients without DM. Acetabuloplasty was performed more frequently in the control group (P=.01). There were no other statistically significant differences detected in terms of demographics, preoperative radiographic imaging, intraoperative findings, procedures, preoperative scores, follow-up scores, revision rates, rates of conversion to total hip arthroplasty, or complication rates. Patients with DM demonstrated favorable improvements at 2 or more years after arthroscopic labral treatment when compared with a matched control group without DM. The DM group demonstrated a non-statistically significant trend toward inferior outcomes in all patient-reported outcomes, visual analog scale score, and satisfaction. [Orthopedics. 2021;44(4):241-248.].
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Rajamäki TJ, Moilanen T, Puolakka PA, Hietaharju A, Jämsen E. Is the Preoperative Use of Antidepressants and Benzodiazepines Associated with Opioid and Other Analgesic Use After Hip and Knee Arthroplasty? Clin Orthop Relat Res 2021; 479:2268-2280. [PMID: 33982976 PMCID: PMC8445559 DOI: 10.1097/corr.0000000000001793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 04/05/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Mental health disorders can occur in patients with pain conditions, and there have been reports of an increased risk of persistent pain after THA and TKA among patients who have psychological distress. Persistent pain may result in the prolonged consumption of opioids and other analgesics, which may expose patients to adverse drug events and narcotic habituation or addiction. However, the degree to which preoperative use of antidepressants or benzodiazepines is associated with prolonged analgesic use after surgery is not well quantified. QUESTION/PURPOSES (1) Is the preoperative use of antidepressants or benzodiazepine medications associated with a greater postoperative use of opioids, NSAIDs, or acetaminophen? (2) Is the proportion of patients still using opioid analgesics 1 year after arthroplasty higher among patients who were taking antidepressants or benzodiazepine medications before surgery, after controlling for relevant confounding variables? (3) Does analgesic drug use decrease after surgery in patients with a history of antidepressant or benzodiazepine use? (4) Does the proportion of patients using antidepressants or benzodiazepines change after joint arthroplasty compared with before? METHODS Of the 10,138 patients who underwent hip arthroplasty and the 9930 patients who underwent knee arthroplasty at Coxa Hospital for Joint Replacement, Tampere, Finland, between 2002 and 2013, those who had primary joint arthroplasty for primary osteoarthritis (64% [6502 of 10,138] of patients with hip surgery and 82% [8099 of 9930] who had knee surgery) were considered potentially eligible. After exclusion of another 8% (845 of 10,138) and 13% (1308 of 9930) of patients because they had revision or another joint arthroplasty within 2 years of the index surgery, 56% (5657 of 10,138) of patients with hip arthroplasty and 68% (6791 of 9930) of patients with knee arthroplasty were included in this retrospective registry study. Patients who filled prescriptions for antidepressants or benzodiazepines were identified from a nationwide drug prescription register, and information on the filled prescriptions for opioids (mild and strong), NSAIDs, and acetaminophen were extracted from the same database. For the analyses, subgroups were created according to the status of benzodiazepine and antidepressant use during the 6 months before surgery. First, the proportions of patients who used opioids and any analgesics (that is, opioids, NSAIDs, or acetaminophen) were calculated. Then, multivariable logistic regression adjusted with age, gender, joint, Charlson Comorbidity Index, BMI, laterality (unilateral/same-day bilateral), and preoperative analgesic use was performed to calculate odds ratios for any analgesic use and opioid use 1 year postoperatively. Additionally, the proportion of patients who used antidepressants and benzodiazepines was calculated for 2 years before and 2 years after surgery. RESULTS At 1 year postoperatively, patients with a history of antidepressant or benzodiazepine use were more likely to fill prescriptions for any analgesics than were patients without a history of antidepressant or benzodiazepine use (adjusted odds ratios 1.9 [95% confidence interval 1.6 to 2.2]; p < 0.001 and 1.8 [95% CI 1.6 to 2.0]; p < 0.001, respectively). Similarly, patients with a history of antidepressant or benzodiazepine use were more likely to fill prescriptions for opioids than patients without a history of antidepressant or benzodiazepine use (adjusted ORs 2.1 [95% CI 1.7 to 2.7]; p < 0.001 and 2.0 [95% CI 1.6 to 2.4]; p < 0.001, respectively). Nevertheless, the proportion of patients who filled any analgesic prescription was smaller 1 year after surgery than preoperatively in patients with a history of antidepressant (42% [439 of 1038] versus 55% [568 of 1038]; p < 0.001) and/or benzodiazepine use (40% [801 of 2008] versus 55% [1098 of 2008]; p < 0.001). The proportion of patients who used antidepressants and/or benzodiazepines was essentially stable during the observation period. CONCLUSION Surgeons should be aware of the increased risk of prolonged opioid and other analgesic use after surgery among patients who were on preoperative antidepressant and/or benzodiazepine therapy, and they should have candid discussions with patients referred for elective joint arthroplasty about this possibility. Further studies are needed to identify the most effective methods to reduce prolonged postoperative opioid use among these patients. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Tuomas J Rajamäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Coxa Hospital for Joint Replacement, Tampere, Finland
| | | | - Pia A Puolakka
- Department of Anaesthesia, Tampere University Hospital, Tampere, Finland
| | - Aki Hietaharju
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Neurology, Tampere University Hospital, Tampere, Finland
| | - Esa Jämsen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Coxa Hospital for Joint Replacement, Tampere, Finland
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Perioperative factors associated with persistent post-surgical pain after hysterectomy, cesarean section, prostatectomy, and donor nephrectomy: a systematic review and meta-analysis. Pain 2021; 163:425-435. [PMID: 34121077 DOI: 10.1097/j.pain.0000000000002361] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 05/04/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Persistent postsurgical pain (PPSP) is a common, and often disabling postoperative morbidity, but many questions remain about factors associated with PPSP. This systematic review and meta-analysis aimed to identify preoperative, intraoperative and postoperative factors associated with PPSP after gynecological surgeries, namely hysterectomy and cesarean section (C-section), and urological surgeries, namely prostatectomy and donor nephrectomy. Overall, 18 gynecological surgery studies, 4 prostatectomy studies, and 2 donor nephrectomy studies met the review criteria providing data that could be meta-analyzed. Average (±SD) PPSP occurrence after gynecological surgery was 20±11%; factors associated with increased risk of PPSP included smoking, preoperative abdominal or pelvic pain, preoperative pain elsewhere in the body, longer duration of surgery, more intense acute postoperative pain, and surgical wound infection. The use of neuraxial anesthesia was associated with decreased PPSP risk. Average PPSP occurrence was 20±9% after prostatectomy and 15±2% after donor nephrectomy. For urological procedures, the existing data did not allow for identification of significant factors associated with PPSP, except for laparoscopic and hand assisted laparoscopic approaches that were associated with lower incidence of PPSP for donor nephrectomy, and the use of neuraxial anesthesia which was associated with lower incidence of PPSP after prostatectomy. PPSP after gynecological and urological surgeries is common. This systematic review identified important factors associated with C-section and hysterectomy that can help identify women who are at high risk of PPSP. More high-quality studies with consistent methodology are needed to understand the factors associated with PPSP risk, particularly for surgeries such as prostatectomy and nephrectomy.
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Diabetes Mellitus Blunts the Symptoms, Physical Function, and Health-Related Quality of Life Benefits of Total Knee Arthroplasty: A Systematic Review With Meta-analysis of Data From More Than 17 000 Patients. J Orthop Sports Phys Ther 2021; 51:269-280. [PMID: 33870736 DOI: 10.2519/jospt.2021.9515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To compare physical function, pain, impairments (stiffness, range of motion, and strength), and health-related quality of life (HRQoL) outcomes between patients with and without diabetes mellitus, before and after a total knee arthroplasty (TKA). DESIGN Prognosis systematic review. LITERATURE SEARCH We searched MEDLINE/PubMed, CINAHL, SPORTDiscus, and Web of Science to August 2019. STUDY SELECTION CRITERIA We included longitudinal studies that examined physical function, pain, impairments, and HRQoL outcomes among patients receiving a TKA and with or without diabetes. DATA SYNTHESIS For quantitative synthesis, we stratified outcomes based on time relative to TKA: preoperative, less than 1 year after a TKA (early postoperative), and 1 year or more after a TKA (late postoperative). We used random-effects meta-analysis to calculate standardized mean differences (SMDs) and 95% confidence intervals (CIs). We used the Grading of Recommendations Assessment, Development and Evaluation system for qualitative synthesis. RESULTS We included 21 studies (n = 17 472 patients). Patients with diabetes mellitus had worse preoperative physical function (SMD, -0.16; 95% CI: -0.24, -0.08) and HRQoL (SMD, -0.16; 95% CI: -0.26, -0.05), worse early postoperative pain (SMD, -0.22; 95% CI: -0.39, -0.05) and strength (SMD, -0.45; 95% CI: -0.77, -0.14), and worse late postoperative physical function (SMD, -0.23; 95% CI: -0.40, -0.06), range of motion (SMD, -0.23; 95% CI: -0.46, 0.00), and HRQoL (SMD, -0.19; 95% CI: -0.29, -0.08) than patients without diabetes mellitus. The overall risk of bias across studies was high, and the certainty of evidence ranged from low to very low. CONCLUSION Patients with diabetes mellitus had worse patient-reported and clinician-assessed outcomes before and after a TKA. Given the limitations of included studies, these results may change with future research. J Orthop Sports Phys Ther 2021;51(6):269-280. Epub 19 Apr 2021. doi:10.2519/jospt.2021.9515.
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Functional Outcomes and Health-Related Quality of Life Before and After Primary Total Knee Replacement for Patients From Diverse Geographic Regions. J Arthroplasty 2021; 36:1958-1965. [PMID: 33581972 DOI: 10.1016/j.arth.2021.01.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 12/30/2020] [Accepted: 01/17/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The purpose of this study was to investigate whether patient-reported knee function and health status before and after primary total knee replacement (TKR) at an academic medical center differs among patients from diverse geographic regions. METHODS We assessed patient-reported outcomes (PROs) as measured by the Oxford Knee Score (OKS) and EuroQoL-5D (EQ-5D) in 2855 TKR patients at preprimary and one year postprimary TKR procedure between January 1, 2012 and June 30, 2014. We compared the demographic characteristics, response rates, and changes in OKS, EQ-5D, and EQ visual analog scale among local, regional, and national patient groups. Patient- or hospital-related predictors of the postoperative scores were identified after controlling for preoperative scores on the PRO measures. RESULTS Local patients had more comorbid conditions. Groups were similar in clinical outcomes such as length of stay at hospital, complication, and reoperation rates. Local, regional, and national patients had similar response rates and reported a similar level of knee function and health-related quality of life before and after TKR. Eighty nine percent had clinically important improvement on OKS, 69% on EQ-5D index, and 28% EQ visual analog scale, and there were no differences among groups in the proportions of clinically meaningful change. Better postoperative PRO scores were associated with older age, shorter hospital stay, fewer comorbidities, nonsmoking status, fewer complications, and private health insurance. CONCLUSION Some patient characteristics such as comorbidities were greater in the local patient cohort versus the national cohort. Nevertheless, clinical outcomes and PROs were comparable across all geographic tiers.
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18
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Levy N, Lirk P. Regional anaesthesia in patients with diabetes. Anaesthesia 2021; 76 Suppl 1:127-135. [PMID: 33426661 DOI: 10.1111/anae.15258] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2020] [Indexed: 12/11/2022]
Abstract
Diabetes is the most common metabolic condition worldwide and about 20% of surgical patients will have this condition. It is a major risk-factor for worse outcomes after surgery including mortality; infective and non-infective complications; and increased length of stay. However, diabetes is a modifiable risk-factor, and programs to improve medical management have the potential to reduce peri-operative complications and the risk of harm. Regional anaesthesia has well-documented benefits in promoting the restoration of function but there are legitimate concerns that the incidence of complications of regional anaesthesia in patients with diabetes is higher. The aim of this review is to explore in detail the various potential advantages and disadvantages of regional anaesthesia in patients with diabetes. This, in turn, will allow practitioners to undertake more informed shared decision-making and potentially modify their anaesthetic technique for patients with diabetes.
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Affiliation(s)
- N Levy
- Department of Anaesthesia, West Suffolk Hospital, Bury St. Edmunds, Suffolk, UK
| | - P Lirk
- Department of Anesthesiology, Peri-operative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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19
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Alkindy T. Dysglycemia and Arthroplasty Outcomes: A Review. Cureus 2020; 12:e10239. [PMID: 32923294 PMCID: PMC7478689 DOI: 10.7759/cureus.10239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Arthroplasty (ART) is a common surgery and it is on the rise worldwide due to increasing longevity and osteoarthritis. The effects of perioperative hyperglycemia on the outcomes are largely unknown and the current review aimed to assess the impact of perioperative hyperglycemia on ART outcomes. The literature in PubMed and Google Scholar was searched for relevant articles published in the last ten years up to February 2020. The keywords knee ART, hip ART, diabetes mellitus (DM) impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and impaired glycated hemoglobin (HbA1c)were used. Among the 113 articles retrieved, 34 full-texts were eligible, and only 21 studies (17 from the USA, three from Europe, and two from Asia) met the inclusion criteria for the systematic review. The authors' names, year of publication, country, type of study, number of patients, and duration of the study were reported. The studies reviewed showed high ART complication rates including infections, loosening, increasing severity and depth of infection, more pain, and higher costs with high perioperative hyperglycemia. The cut-off glycated hemoglobin values associated with complications ranged from 6.7 to >8.
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Affiliation(s)
- Talal Alkindy
- Orthopaedics, University of Tabuk, College of Medicine, Tabuk, SAU
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20
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Eitner A, Richter F, Schaible HG. Physiologie der Schmerzentstehung in der Peripherie. AKTUEL RHEUMATOL 2020. [DOI: 10.1055/a-1203-1192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
ZusammenfassungDieser Beitrag gibt einen Überblick über den Kenntnisstand zu den
Mechanismen der Schmerzentstehung im Gelenk. Er fokussiert sich auf den Vorgang
der Nozizeption in nozizeptiven Nervenfasern des Gelenks und stellt dar, wie
Krankheitsprozesse im Gelenk auf Nozizeptoren wirken. Während
Nozizeptoren im normalen Gelenk eine hohe Erregungsschwelle besitzen und nur
durch hochintensive Reize aktiviert werden, kommt es bei Gelenkerkrankungen
häufig zu einer Sensibilisierung dieser Nervenfasern, sodass sie bereits
auf leichte Reize (Bewegungen, Palpation) ansprechen und nach zentraler
Verarbeitung Schmerzempfindungen auslösen. Eine Sensibilisierung wird
meistens durch Entzündungsmediatoren ausgelöst, für die
die Nozizeptoren Rezeptoren besitzen. Werden Nervenfasern im Erkrankungsprozess
geschädigt, können neuropathische Schmerzmechanismen
hinzukommen. Chronische Gelenkerkrankungen sind durch entzündliche und
destruktive Prozesse charakterisiert. Sowohl bei primären Arthritiden
als auch bei Arthrosen sind entzündliche Prozesse für die
Sensibilisierung der Nozizeptoren verantwortlich. Dafür werden neben den
Prostaglandinen auch proinflammatorische Zytokine und der Nervenwachstumsfaktor
(NGF) verantwortlich gemacht, für die viele Nozizeptoren Rezeptoren
exprimieren. Demgemäß sind diese Moleküle auch Target
innovativer Schmerztherapien, z. B. die Gabe von Antikörpern
gegen NGF bei Arthrose. Besonders für die Neutralisation von TNF ist ein
direkt schmerzlindernder Effekt nachgewiesen, der aus der Unterbrechung von
nozizeptiven Vorgängen am Nozizeptor resultiert. Der direkte
pronozizeptive Effekt der Zytokine und Bindungsstellen für Fc-Fragmente
von Antikörpern an Nozizeptoren zeigen, dass Immunmechanismen auch
für die Schmerzentstehung große Bedeutung haben. Auch
destruktive Gelenkprozesse können Schmerzen verursachen. So kann bereits
die Osteoklastenaktivität im präklinischen Stadium einer
Arthritis Schmerzen verursachen, und nach Ausbruch der Arthritis tragen
Destruktionsprozesse zu Schmerzen bei. Inwieweit die Hemmung der
Osteoklastenaktivität Gelenkschmerzen lindert, wird derzeit erforscht.
Auch weitere neue Ansätze, peripher wirksame Opioide, Cannabinoide und
Ionenkanalblocker werden dargestellt. Schließlich geht der Beitrag auf
generelle/systemische Faktoren ein, die Krankheitsprozesse im Gelenk und
die Schmerzentstehung beeinflussen. Hier wird in erster Linie die Bedeutung des
Diabetes mellitus angesprochen. Diese Stoffwechselerkrankung stellt einen
Risikofaktor für die Entwicklung von Arthrosen dar, und sie
trägt zur Schmerzintensivierung bei. Dabei können
verstärkte Entzündungsprozesse und auch neuropathische
Schmerzkomponenten beteiligt sein.
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Affiliation(s)
- Annett Eitner
- Klinik für Unfall-, Hand-, Wiederherstellungschirurgie,
Universitätsklinikum Jena, Jena
| | - Frank Richter
- Institut für Physiologie 1, Universitätsklinikum Jena,
Jena
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Rajamäki TJ, Puolakka PA, Hietaharju A, Moilanen T, Jämsen E. Predictors of the use of analgesic drugs 1 year after joint replacement: a single-center analysis of 13,000 hip and knee replacements. Arthritis Res Ther 2020; 22:89. [PMID: 32317021 PMCID: PMC7175525 DOI: 10.1186/s13075-020-02184-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 04/07/2020] [Indexed: 12/27/2022] Open
Abstract
Background Pain persists in a moderate number of patients following hip or knee replacement surgery. Persistent pain may subsequently lead to the prolonged consumption of analgesics after surgery and expose patients to the adverse drug events of opioids and NSAIDs, especially in older patients and patients with comorbidities. This study aimed to identify risk factors for the increased use of opioids and other analgesics 1 year after surgery and focused on comorbidities and surgery-related factors. Methods All patients who underwent a primary hip or knee replacement for osteoarthritis from 2002 to 2013 were identified. Redeemed prescriptions for acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), and opioids (mild and strong) were collected from a nationwide Drug Prescription Register. The user rates of analgesics and the adjusted risks ratios for analgesic use 1 year after joint replacement were calculated. Results Of the 6238 hip replacement and 7501 knee replacement recipients, 3591 (26.1%) were still using analgesics 1 year after surgery. Significant predictors of overall analgesic use (acetaminophen, NSAID, or opioid) were (risk ratio (95% CI)) age 65–74.9 years (reference < 65), 1.1 (1.03–1.2); age > 75 years, 1.2 (1.1–1.3); female gender, 1.2 (1.1–1.3); BMI 30–34.9 kg/m2 (reference < 25 kg/m2), 1.1 (1.04–1.2); BMI > 35 kg/m2, 1.4 (1.3–1.6); and a higher number of comorbidities (according to the modified Charlson Comorbidity Index score), 1.2 (1.1–1.4). Diabetes and other comorbidities were not significant independent predictors. Of the other clinical factors, the preoperative use of analgesics, 2.6 (2.5–2.8), and knee surgery, 1.2 (1.1–1.3), predicted the use of analgesics, whereas simultaneous bilateral knee replacement (compared to unilateral procedure) was a protective factor, 0.86 (0.77–0.96). Opioid use was associated with obesity, higher CCI score, epilepsy, knee vs hip surgery, unilateral vs bilateral knee operation, total vs unicompartmental knee replacement, and the preoperative use of analgesics/opioids. Conclusions Obesity (especially BMI > 35 kg/m2) and the preoperative use of analgesics were the strongest predictors of an increased postoperative use of analgesics. It is remarkable that also older age and higher number of comorbidities predicted analgesic use despite these patients being the most vulnerable to adverse drug events.
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Affiliation(s)
| | - Pia A Puolakka
- Department of Anaesthesia, Tampere University Hospital, Tampere, Finland
| | - Aki Hietaharju
- Faculty of Medicine and Health Technology, Tampere University, 33014, Tampere, Finland.,Department of Neurology, Tampere University Hospital, Tampere, Finland
| | | | - Esa Jämsen
- Faculty of Medicine and Health Technology, Tampere University, 33014, Tampere, Finland.,Coxa, Hospital for Joint Replacement, Tampere, Finland
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22
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Regnier SM, Khatibi B, Gabriel RA. Association of diabetes mellitus with postoperative opioid consumption in patients undergoing primary unilateral hip arthroplasty. J Perioper Pract 2020; 31:96-101. [PMID: 32096444 DOI: 10.1177/1750458920903647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Opioids are an indispensable component of perioperative pain management; however, the burgeoning opioid epidemic necessitates research into the risk factors for the development of opioid dependence and abuse following surgery. Diabetes has been identified as a risk factor for prolonged opioid utilisation following non-orthopaedic surgery; however, this association has not been investigated following orthopaedic surgery. To bridge this gap in the literature, we performed a retrospective propensity-matched cohort study in patients undergoing primary unilateral total hip arthroplasty. Propensity-matched cohorts were created to compare patients with and without preexisting diabetes mellitus. Outcomes of interest were opioid utilisation and subjective pain on postoperative day 1. Our results did not identify an association between preexisting diabetes and postoperative pain or opioid utilisation. While this study did not identify an association between diabetes and opioid utilisation following total hip arthroplasty, future studies should pursue a prospective, longitudinal approach and investigate other common orthopaedic procedures.
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Affiliation(s)
- Shane M Regnier
- Department of Anesthesiology, 8784University of California San Diego, San Diego, USA
| | - Bahareh Khatibi
- Department of Anesthesiology, 8784University of California San Diego, San Diego, USA
| | - Rodney A Gabriel
- Department of Anesthesiology, 8784University of California San Diego, San Diego, USA.,Department of Medicine, Division of Biomedical Informatics, 8784University of California San Diego, San Diego, USA
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Alvarez C, Cleveland RJ, Schwartz TA, Renner JB, Murphy LB, Jordan JM, Callahan LF, Golightly YM, Nelson AE. Comorbid conditions and the transition among states of hip osteoarthritis and symptoms in a community-based study: a multi-state time-to-event model approach. Arthritis Res Ther 2020; 22:12. [PMID: 31959228 PMCID: PMC6972032 DOI: 10.1186/s13075-020-2101-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 01/09/2020] [Indexed: 12/22/2022] Open
Abstract
Background We examined the association of three common chronic conditions (obesity, diabetes mellitus [DM], and cardiovascular disease [CVD]) with transitions among states of hip osteoarthritis (HOA). Methods This longitudinal analysis used data from the Johnston County Osteoarthritis Project (JoCo OA, n = 3857), a community-based study in North Carolina, USA, with 18.4 ± 1.5 years of follow-up. Transitions across the following states were modeled: development of radiographic HOA (rHOA; Kellgren-Lawrence grade [KLG] of< 2); development of hip symptoms (self-reported hip pain, aching, or stiffness on most days) or symptomatic HOA (sxHOA; rHOA and symptoms in the same hip), and resolution of symptoms. Obesity (body mass index ≥ 30 kg/m2) and self-reported DM and CVD were the time-dependent comorbid conditions of interest. Markov multi-state models were used to estimate adjusted hazard ratios and 95% confidence intervals to describe the associations between the conditions and HOA states. Results The sample included 33% African Americans, 39% men, with a mean (SD) age of 62.2 (9.8) years; the frequencies of the comorbidities increased substantially over time. When considered individually, obesity was associated with incident hip symptoms, while CVD and DM were associated with reduced symptom resolution. For those with > 1 comorbidity, the likelihood of incident sxHOA increased, while that of symptom resolution significantly decreased. When stratified by sex, the association between obesity and incident symptoms was only seen in women; among men with DM versus men without, there was a significant (~ 75%) reduction in symptom resolution in those with rHOA. When stratified by race, African Americans with DM, versus those without, were much more likely to develop sxHOA. Conclusions Comorbid chronic conditions are common in individuals with OA, and these conditions have a significant impact on the persistence and progression of HOA. OA management decisions, both pharmacologic and non-pharmacologic, should include considerations of the inter-relationships between OA and common comorbidities such as DM and CVD.
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Affiliation(s)
- Carolina Alvarez
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Doc J. Thurston Building, Campus Box #7280, Chapel Hill, NC, 27599-7280, USA
| | - Rebecca J Cleveland
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Doc J. Thurston Building, Campus Box #7280, Chapel Hill, NC, 27599-7280, USA
| | - Todd A Schwartz
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Doc J. Thurston Building, Campus Box #7280, Chapel Hill, NC, 27599-7280, USA.,Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 3106E McGavran-Greenberg Hall, Campus Box #7420, Chapel Hill, NC, 27599-7420, USA
| | - Jordan B Renner
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Doc J. Thurston Building, Campus Box #7280, Chapel Hill, NC, 27599-7280, USA.,Department of Radiology, University of North Carolina at Chapel Hill, 509 Old Infirmary Bldg, Campus Box #7510, Chapel Hill, NC, 27599-7510, USA
| | - Louise B Murphy
- Centers for Disease Control and Prevention, 4770 Buford Highway NE MS S106-7, Atlanta, GA, 30341, USA
| | - Joanne M Jordan
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Doc J. Thurston Building, Campus Box #7280, Chapel Hill, NC, 27599-7280, USA.,School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA.,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Leigh F Callahan
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Doc J. Thurston Building, Campus Box #7280, Chapel Hill, NC, 27599-7280, USA.,School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA.,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Yvonne M Golightly
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Doc J. Thurston Building, Campus Box #7280, Chapel Hill, NC, 27599-7280, USA.,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA.,Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, USA.,Division of Physical Therapy, Department of Allied Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Amanda E Nelson
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Doc J. Thurston Building, Campus Box #7280, Chapel Hill, NC, 27599-7280, USA. .,School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA.
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24
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Lindberg M, Franklin O, Svensson J, Franklin KA. Postoperative pain after colorectal surgery. Int J Colorectal Dis 2020; 35:1265-1272. [PMID: 32318795 PMCID: PMC7320040 DOI: 10.1007/s00384-020-03580-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE Postoperative pain is a keystone in perioperative programs, as pain negatively impacts recovery. This study aimed to evaluate pain after elective colorectal surgery and to identify risk factors for postoperative pain. METHODS This prospective cohort study comprised consecutive patients undergoing elective colorectal surgery within the Enhanced Recovery after Surgery (ERAS) perioperative program between March 2013 and April 2017. The numeric rating scale (NRS) was used to estimate maximum pain. Logistic regression was used to model associations with the type of surgery, age, gender, and comorbidities. RESULTS The cohort comprised 434 of 459 eligible patients. On the day of surgery to postoperative day 3, 50-64% of patients reported moderate to severe pain (NRS 4-10). Postoperative pain was similar for open and minimally invasive rectal surgery, while patients undergoing minimally invasive colonic surgery experienced more pain on the day of surgery and less pain on postoperative days 2 and 3 vs. open colonic surgery. Younger age was associated with more pain every postoperative day and by 0.7 NRS/10 years (95% CI 0.5-0.9, P < 0.001) on the day of surgery, while having diabetes type 2 was associated with less postoperative pain by - 1.3 NRS (95% CI - 2.4 to - 0.2) on the day of surgery. CONCLUSIONS The majority, and young patients in particular, experience moderate to severe pain after open and minimally invasive colorectal surgery, despite following ERAS perioperative program. There is a need for effective and individualized analgesia after colorectal surgery, since the individual pain response to surgery is difficult to predict.
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Affiliation(s)
- Margaretha Lindberg
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, SE-901 85 Umeå, Sweden
| | - Oskar Franklin
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, SE-901 85 Umeå, Sweden
| | - Johan Svensson
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, SE-901 85 Umeå, Sweden ,Department of Statistics, Umeå School of Business, Economics and Statistics, Umeå University, Umeå, Sweden
| | - Karl A. Franklin
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, SE-901 85 Umeå, Sweden
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25
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Guetta O, Vakhrushev A, Dukhno O, Ovnat A, Sebbag G. New results on the safety of laparoscopic sleeve gastrectomy bariatric procedure for type 2 diabetes patients. World J Diabetes 2019; 10:78-86. [PMID: 30788045 PMCID: PMC6379729 DOI: 10.4239/wjd.v10.i2.78] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 01/08/2019] [Accepted: 01/23/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND It has been established that bariatric surgery, including laparoscopic sleeve gastrectomy (LSG), has a positive impact on type 2 diabetes mellitus (T2DM). However, less frequently T2DM is reported as a risk factor for complications with this type of surgery.
AIM To evaluate the safety of LSG in T2DM.
METHODS A retrospective cohort study was conducted over patients admitted for LSG from January 2008 to May 2015. Data was collected through digitized records. Any deviation from normal postoperative care within the first 60 d was defined as an early complication, and further categorized into mild or severe.
RESULTS Nine hundred eighty-four patients underwent LSG, among these 143 (14.5%) were diagnosed with T2DM. There were 19 complications in the T2DM group (13.3%) compared to 59 cases in the non-T2DM (7.0%). Out of 19 complications in the T2DM group, 12 were mild (8.4%) and 7 were severe (4.9%). Compared to the non-T2DM group, patients had a higher risk for mild complications (Odds-ratio 2.316, CI: 1.163-4.611, P = 0.017), but not for severe ones (P = 0.615). An increase of 1% in hemoglobin A1c levels was associated with a 40.7% increased risk for severe complications (P = 0.013, CI: 1.074-1.843) but not for mild ones.
CONCLUSION Our data suggest that LSG is relatively safe for patients with T2DM. Whether pre-operative control of hemoglobin A1c level will lower the complications rate has to be prospectively studied.
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Affiliation(s)
- Ohad Guetta
- Department General Surgery B, Soroka University Medical Center, Be’er Sheva 8457108, Israel
| | - Alex Vakhrushev
- Department General Surgery B, Soroka University Medical Center, Be’er Sheva 8457108, Israel
| | - Oleg Dukhno
- Department General Surgery B, Soroka University Medical Center, Be’er Sheva 8457108, Israel
| | - Amnon Ovnat
- Department General Surgery B, Soroka University Medical Center, Be’er Sheva 8457108, Israel
| | - Gilbert Sebbag
- Department General Surgery B, Soroka University Medical Center, Be’er Sheva 8457108, Israel
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26
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Guillemot-Legris O, Buisseret B, Mutemberezi V, Hermans E, Deumens R, Alhouayek M, Muccioli GG. Post-operative pain in mice is prolonged by diet-induced obesity and rescued by dietary intervention. Brain Behav Immun 2018; 74:96-105. [PMID: 30071254 DOI: 10.1016/j.bbi.2018.07.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 07/08/2018] [Accepted: 07/25/2018] [Indexed: 12/29/2022] Open
Abstract
The prevalence of obesity has increased at an alarming rate during past decades. Obesity is associated with pathophysiological disorders that can evolve and increase the risk of heart disease, diabetes and hypertension. While the impact of diabetes on post-operative recovery is now known, the consequences of obesity on post-operative pain remain much less explored. Here, we show that obesity affects post-operative pain resolution and leads to a chronic pain state in mice. Several mechanisms were identified as implicated in the prolonged post-operative pain. Indeed, we found that following a hind paw incision, high fat diet prolonged glial cell activation in the spinal cord. It also altered the expression of neurotrophins and increased inflammatory and endoplasmic reticulum stress markers in both central and peripheral nervous systems. Moreover, we show that a dietary intervention, leading to weight reduction and decreased inflammation, was able to restore normal pain sensitivity in mice suffering from chronic pain for more than 10 weeks. In conclusion, our data demonstrate that obesity is responsible for pain chronicization. This is clearly of importance in a clinical post-operative setting.
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Affiliation(s)
- Owein Guillemot-Legris
- Bioanalysis and Pharmacology of Bioactive Lipids Research Group, Louvain Drug Research Institute, Université catholique de Louvain, Avenue Mounier 72 (B1.72.01), 1200 Brussels, Belgium
| | - Baptiste Buisseret
- Bioanalysis and Pharmacology of Bioactive Lipids Research Group, Louvain Drug Research Institute, Université catholique de Louvain, Avenue Mounier 72 (B1.72.01), 1200 Brussels, Belgium
| | - Valentin Mutemberezi
- Bioanalysis and Pharmacology of Bioactive Lipids Research Group, Louvain Drug Research Institute, Université catholique de Louvain, Avenue Mounier 72 (B1.72.01), 1200 Brussels, Belgium
| | - Emmanuel Hermans
- Neuropharmacology Group, Institute of Neuroscience, Université catholique de Louvain, Avenue Hippocrate 54 (B1.54.10), 1200 Brussels, Belgium
| | - Ronald Deumens
- Neuropharmacology Group, Institute of Neuroscience, Université catholique de Louvain, Avenue Hippocrate 54 (B1.54.10), 1200 Brussels, Belgium
| | - Mireille Alhouayek
- Bioanalysis and Pharmacology of Bioactive Lipids Research Group, Louvain Drug Research Institute, Université catholique de Louvain, Avenue Mounier 72 (B1.72.01), 1200 Brussels, Belgium
| | - Giulio G Muccioli
- Bioanalysis and Pharmacology of Bioactive Lipids Research Group, Louvain Drug Research Institute, Université catholique de Louvain, Avenue Mounier 72 (B1.72.01), 1200 Brussels, Belgium.
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27
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Abdullah HR, Ranjakunalan N, Yeo W, Tan MH, Poopalalingam R, Sim YE. Association between preoperative anaemia and blood transfusion with long-term functional and quality of life outcomes amongst patients undergoing primary total knee arthroplasty in Singapore: a single-centre retrospective study. Qual Life Res 2018; 28:85-98. [PMID: 30203301 DOI: 10.1007/s11136-018-1996-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2018] [Indexed: 12/22/2022]
Abstract
PURPOSE Preoperative anaemia affects up to one-third of patients undergoing total knee arthroplasty (TKA) and is associated with increased blood transfusion and prolonged hospitalisation. Prior studies have associated preoperative anaemia with poorer functional recovery after total hip arthroplasty. However, the association between preoperative anaemia and functional outcomes following TKA is unknown. We aim to determine whether preoperative anaemia and perioperative blood transfusion affect health-related quality of life (HRQoL) and functional outcomes following TKA. METHODS Retrospective analysis of 1994 patients who underwent primary unilateral TKA from 2013 to 2014 was performed. Anaemia was defined according to the World Health Organisation definition. Baseline and 6-month postoperative HRQoL was assessed with the 36-Item Short Form Survey (SF-36), while function was assessed with Oxford Knee Score (OKS) and Knee Society Function Score (KSFS). Physical function (PF), role physical (RP), bodily pain (BP), social function (SF) and role emotional (RE) domains of SF-36, OKS and KSFS demonstrated significant change greater than the minimal clinically important difference between baseline and 6 months. Analysis of covariance (ANCOVA) was performed to identify predictors of 6-month scores. RESULTS The incidence of preoperative anaemia was 22.3%. 4.3% of patients received blood transfusions. Preoperative anaemia and perioperative blood transfusion did not significantly affect SF-36, KSFS and OKS scores at 6 months postoperatively. Poor baseline SF-36, KSS and OKS scores and high BMI ≥ 37.5 kg/m2 are consistently associated with lower scores at 6 months. CONCLUSION Preoperative anaemia and perioperative blood transfusion did not significantly affect HRQoL and functional outcomes following primary TKA. Poor baseline and obesity were associated with poorer outcomes.
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Affiliation(s)
| | | | - William Yeo
- Orthopaedic Diagnostic Center, Singapore General Hospital, Singapore, Singapore
| | - Mann Hong Tan
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | | | - Yilin Eileen Sim
- Department of Anaesthesia, Singapore General Hospital, Singapore, Singapore.
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Namba RS, Singh A, Paxton EW, Inacio MCS. Patient Factors Associated With Prolonged Postoperative Opioid Use After Total Knee Arthroplasty. J Arthroplasty 2018; 33:2449-2454. [PMID: 29753617 DOI: 10.1016/j.arth.2018.03.068] [Citation(s) in RCA: 121] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 03/23/2018] [Accepted: 03/27/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Pain persists in a moderate proportion of patients after total knee arthroplasty (TKA). Identifying patient factors that are associated with persistent pain may lead to improved care. PURPOSE The purpose of the study was to identify preoperative factors associated with increased opioid prescriptions after TKA. METHODS A retrospective cohort study of TKAs in an integrated health-care system (January 2008-December 2011) was conducted. The number of opioid prescriptions per 90-day period after TKA (up to 1 year), was the outcome of interest. Patient risk factors that were evaluated included demographics, pain prescriptions, comorbidities, and chronic pain conditions. Multivariable Poisson regression models were employed. RESULTS The median age for 23,726 patients was 67 years. Before surgery, 60.0% used opioids. Three months after surgery, 41.2% of patients continued using opioids. Factors associated with greater opioid use included: younger age (odds ratio [OR] = 0.83, 95% confidence interval [CI] 0.82-0.84 per 10-year increase), liver disease (OR = 1.11, 95% CI 1.06-1.16), preoperative nonsteroidal anti-inflammatory drug use (OR = 1.09, 95% CI 1.07-1.10), anxiety (OR = 1.05, 95% CI 1.03-1.08), substance abuse (OR = 1.03, 95% CI 1.00-1.06), diabetes mellitus (OR = 1.03, 95% CI 1.01-1.05), preoperative opioid use (OR = 1.04, 95% CI 1.04-1.04), back pain (OR = 1.23, 95% CI 1.18-1.127), congestive heart failure (OR = 1.16, 95% CI 1.06-1.27), depression (OR = 1.14, 95% CI 1.09-1.18), fibromyalgia (OR = 1.10, 95% CI 1.02-1.18), hypertension (OR = 1.06, 95% CI 1.02-1.10), nonspecific chronic pain (OR = 1.06, 95% CI 1.02-1.10), black race (OR = 1.17, 95% CI 1.12-1.23), and chronic lung disease (OR = 1.05, 95% CI 1.01-1.10). CONCLUSION Several preoperative factors were associated with prolonged opioid use after TKA, and their identification can assist providers guide pain management. Avoidance or weaning of preoperative opioids should be considered.
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Affiliation(s)
- Robert S Namba
- Southern California Permanente Medical Group, Irvine, California
| | - Anshuman Singh
- Southern California Permanente Medical Group, San Diego, California
| | - Elizabeth W Paxton
- Kaiser Permanente, Surgical Outcomes and Analysis, San Diego, California
| | - Maria C S Inacio
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
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29
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Podmore B, Hutchings A, van der Meulen J, Aggarwal A, Konan S. Impact of comorbid conditions on outcomes of hip and knee replacement surgery: a systematic review and meta-analysis. BMJ Open 2018; 8:e021784. [PMID: 29997141 PMCID: PMC6082478 DOI: 10.1136/bmjopen-2018-021784] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To systematically perform a meta-analysis of the association between different comorbid conditions on safety (short-term outcomes) and effectiveness (long-term outcomes) in patients undergoing hip and knee replacement surgery. DESIGN Systematic review and meta-analysis. METHODS Medline, Embase and CINAHL Plus were searched up to May 2017. We included all studies that reported data to allow the calculation of a pooled OR for the impact of 11 comorbid conditions on 10 outcomes (including surgical complications, readmissions, mortality, function, health-related quality of life, pain and revision surgery). The quality of included studies was assessed using a modified Newcastle-Ottawa Scale. Continuous outcomes were converted to ORs using the Hasselblad and Hedges approach. Results were combined using a random-effects meta-analysis. OUTCOMES The primary outcome was the adjusted OR for the impact of each 11 comorbid condition on each of the 10 outcomes compared with patients without the comorbid condition. Where the adjusted OR was not available the secondary outcome was the crude OR. RESULTS 70 studies were included with 16 (23%) reporting on at least 100 000 patients and 9 (13%) were of high quality. We found that comorbidities increased the short-term risk of hospital readmissions (8 of 11 conditions) and mortality (8 of 11 conditions). The impact on surgical complications was inconsistent across comorbid conditions. In the long term, comorbid conditions increased the risk of revision surgery (6 of 11 conditions) and long-term mortality (7 of 11 conditions). The long-term impact on function, quality of life and pain varied across comorbid conditions. CONCLUSIONS This systematic review shows that comorbidities predominantly have an impact on the safety of hip and knee replacement surgery but little impact on its effectiveness. There is a need for high-quality studies also considering the severity of comorbid conditions.
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MESH Headings
- Arthroplasty, Replacement, Hip/adverse effects
- Arthroplasty, Replacement, Hip/mortality
- Arthroplasty, Replacement, Hip/psychology
- Arthroplasty, Replacement, Knee/adverse effects
- Arthroplasty, Replacement, Knee/mortality
- Arthroplasty, Replacement, Knee/psychology
- Comorbidity
- Humans
- Patient Readmission/statistics & numerical data
- Postoperative Complications/epidemiology
- Quality of Life
- Recovery of Function
- Reoperation/statistics & numerical data
- Risk Factors
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Affiliation(s)
- Bélène Podmore
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
| | - Andrew Hutchings
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
| | - Jan van der Meulen
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
| | - Ajay Aggarwal
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
| | - Sujith Konan
- Orthopaedics and Trauma, University College London Hospitals NHS Foundation Trust, London, UK
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30
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Rudy MD, Ahuja NK, Aaronson AJ. Diabetes and Hyperglycemia in Lower-Extremity Total Joint Arthroplasty. JBJS Rev 2018; 6:e10. [DOI: 10.2106/jbjs.rvw.17.00146] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Stolarczyk A, Sarzyńska S, Gondek A, Cudnoch-Jędrzejewska A. Influence of diabetes on tissue healing in orthopaedic injuries. Clin Exp Pharmacol Physiol 2018; 45:619-627. [PMID: 29570835 DOI: 10.1111/1440-1681.12939] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 02/15/2018] [Accepted: 03/12/2018] [Indexed: 12/22/2022]
Abstract
Diabetes is a group of metabolic diseases characterized by hyperglycaemia resulting from the defective action or secretion of insulin. Chronic hyperglycaemia can lead to the damage, dysfunction and failure of various organs. In the context of complications of healing and orthopaedic rehabilitation, vascular (microangiopathy) and nerve (neuropathy) disorders deserve particular attention. About 12% of the patients admitted to orthopaedic departments have diabetes. Studies indicate that there is an indisputable link between diabetes and: an increased risk of fractures, the difficult healing of injuries of bones, ligaments and musculotendinous. It appears that one of the main reasons for this is non-enzymatic glycosylation (glycation) of collagen molecules, a phenomenon observed in the elderly and diabetic populations, as it leads to the formation of advanced glycation end products (AGEs). Collagen is one of the major connective tissue components, and is therefore part of ligaments, tendons and bones. AGEs affect the weakening of its structure and biomechanical properties, and thus also affects the weakening of the structure and properties of the above-mentioned tissues. The aim of the study is to undertake an overview of the current knowledge of the impact of diabetes on the risk of some injuries and subsequent healing and rehabilitation of patients following orthopaedic injuries.
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Affiliation(s)
- Artur Stolarczyk
- Department of Clinical Rehabilitation, Second Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Sylwia Sarzyńska
- Department of Orthopaedics and Traumatology, Medical University of Warsaw, Warsaw, Poland
| | - Agata Gondek
- Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Warsaw, Poland
| | - Agnieszka Cudnoch-Jędrzejewska
- Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Warsaw, Poland
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Childers CP, Siletz AE, Singer ES, Faltermeier C, Hu QL, Ko CY, Golladay GJ, Kates SL, Wick EC, Maggard-Gibbons M. Surgical Technical Evidence Review for Elective Total Joint Replacement Conducted for the AHRQ Safety Program for Improving Surgical Care and Recovery. Geriatr Orthop Surg Rehabil 2018; 9:2151458518754451. [PMID: 29468091 PMCID: PMC5813847 DOI: 10.1177/2151458518754451] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 11/30/2017] [Accepted: 12/28/2017] [Indexed: 12/12/2022] Open
Abstract
Background: Use of enhanced recovery pathways (ERPs) can improve patient outcomes, yet national implementation of these pathways remains low. The Agency for Healthcare Research and Quality (AHRQ; funder), the American College of Surgeons, and the Johns Hopkins Medicine Armstrong Institute for Patent Safety and Quality have developed the Safety Program for Improving Surgical Care and Recovery—a national effort to catalyze implementation of practices to improve perioperative care and enhance recovery of surgical patients. This review synthesizes evidence that can be used to develop a protocol for elective total knee arthroplasty (TKA) and total hip arthroplasty (THA). Study Design: This review focuses on potential components of the protocol relevant to surgeons; anesthesia components are reported separately. Components were identified through review of existing pathways and from consultation with technical experts. For each, a structured review of MEDLINE identified systematic reviews, randomized trials, and observational studies that reported on these components in patients undergoing elective TKA/THA. This primary evidence review was combined with existing clinical guidelines in a narrative format. Results: Sixteen components were reviewed. Of the 10 preoperative components, most were focused on risk factor assessment including anemia, diabetes mellitus, tobacco use, obesity, nutrition, immune-modulating therapy, and opiates. Preoperative education, venous thromboembolism (VTE) prophylaxis, and bathing/Staphylococcus aureus decolonization were also included. The routine use of drains was the only intraoperative component evaluated. The 5 postoperative components included early mobilization, continuous passive motion, extended duration VTE prophylaxis, early oral alimentation, and discharge planning. Conclusion: This review synthesizes the evidence supporting potential surgical components of an ERP for elective TKA/THA. The AHRQ Safety Program for Improving Surgical Care and Recovery aims to guide hospitals and surgeons in identifying the best practices to implement in the surgical care of TKA and THA patients.
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Affiliation(s)
| | - Anaar E Siletz
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Emily S Singer
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | | | - Q Lina Hu
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,American College of Surgeons, Chicago, IL, USA
| | - Clifford Y Ko
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,American College of Surgeons, Chicago, IL, USA
| | - Gregory J Golladay
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Stephen L Kates
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Elizabeth C Wick
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University, Baltimore, MD, USA
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Eitner A, Hofmann GO, Schaible HG. Mechanisms of Osteoarthritic Pain. Studies in Humans and Experimental Models. Front Mol Neurosci 2017; 10:349. [PMID: 29163027 PMCID: PMC5675866 DOI: 10.3389/fnmol.2017.00349] [Citation(s) in RCA: 130] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 10/13/2017] [Indexed: 12/12/2022] Open
Abstract
Pain due to osteoarthritis (OA) is one of the most frequent causes of chronic pain. However, the mechanisms of OA pain are poorly understood. This review addresses the mechanisms which are thought to be involved in OA pain, derived from studies on pain mechanisms in humans and in experimental models of OA. Three areas will be considered, namely local processes in the joint associated with OA pain, neuronal mechanisms involved in OA pain, and general factors which influence OA pain. Except the cartilage all structures of the joints are innervated by nociceptors. Although the hallmark of OA is the degradation of the cartilage, OA joints show multiple structural alterations of cartilage, bone and synovial tissue. In particular synovitis and bone marrow lesions have been proposed to determine OA pain whereas the contribution of the other pathologies to pain generation has been studied less. Concerning the peripheral neuronal mechanisms of OA pain, peripheral nociceptive sensitization was shown, and neuropathic mechanisms may be involved at some stages. Structural changes of joint innervation such as local loss and/or sprouting of nerve fibers were shown. In addition, central sensitization, reduction of descending inhibition, descending excitation and cortical atrophies were observed in OA. The combination of different neuronal mechanisms may define the particular pain phenotype in an OA patient. Among mediators involved in OA pain, nerve growth factor (NGF) is in the focus because antibodies against NGF significantly reduce OA pain. Several studies show that neutralization of interleukin-1β and TNF may reduce OA pain. Many patients with OA exhibit comorbidities such as obesity, low grade systemic inflammation and diabetes mellitus. These comorbidities can significantly influence the course of OA, and pain research just began to study the significance of such factors in pain generation. In addition, psychologic and socioeconomic factors may aggravate OA pain, and in some cases genetic factors influencing OA pain were found. Considering the local factors in the joint, the neuronal processes and the comorbidities, a better definition of OA pain phenotypes may become possible. Studies are under way in order to improve OA and OA pain monitoring.
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Affiliation(s)
- Annett Eitner
- Department of Physiology, University Hospital Jena, Friedrich Schiller University, Jena, Germany
| | - Gunther O Hofmann
- Department of Traumatology and Orthopedic Surgery, University Hospital Jena, Friedrich Schiller University, Jena, Germany.,Trauma Center Bergmannstrost Halle, Halle, Germany
| | - Hans-Georg Schaible
- Department of Physiology, University Hospital Jena, Friedrich Schiller University, Jena, Germany
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Webb ML, Golinvaux NS, Ibe IK, Bovonratwet P, Ellman MS, Grauer JN. Comparison of Perioperative Adverse Event Rates After Total Knee Arthroplasty in Patients With Diabetes: Insulin Dependence Makes a Difference. J Arthroplasty 2017; 32:2947-2951. [PMID: 28559194 DOI: 10.1016/j.arth.2017.04.032] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 03/14/2017] [Accepted: 04/18/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) is an effective treatment option for patients with advanced osteoarthritis and has become one of the most frequently performed orthopedic procedures. With the increasing prevalence of diabetes mellitus (DM), the burden of its sequela and associated surgical complications has also increased. For these reasons, it is important to understand the association between DM and the rates of perioperative adverse events after TKA. METHODS A retrospective cohort study was conducted using the American College of Surgeons National Surgical Quality Improvement Program database. Patients who underwent TKA between 2005 and 2014 were identified and characterized as having insulin-dependent DM (IDDM), non-insulin-dependent DM (NIDDM), or not having DM. Multivariate Poisson regression was used to control for demographic and comorbid factors and to assess the relative risks of multiple adverse events in the initial 30 postoperative days. RESULTS A total of 114,102 patients who underwent TKA were selected (IDDM = 4881 [4.3%]; NIDDM = 15,367 [13.5%]; and no DM = 93,854 [82.2%]). Patients with NIDDM were found to be at greater risk for 2 of 17 adverse events studied relative to patients without DM. However, patients with IDDM were found to be at greater risk for 12 of 17 adverse events studied relative to patients without DM. CONCLUSION In comparison with patients with NIDDM, patients with IDDM are at greater risk for many more perioperative adverse outcomes relative to patients without DM. These findings have important implications for patient selection, preoperative risk stratification, and postoperative expectations.
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Affiliation(s)
- Matthew L Webb
- Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nicholas S Golinvaux
- Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Izuchukwu K Ibe
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut
| | - Patawut Bovonratwet
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut
| | - Matthew S Ellman
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Jonathan N Grauer
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut
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36
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Inacio MCS, Hansen C, Pratt NL, Graves SE, Roughead EE. Risk factors for persistent and new chronic opioid use in patients undergoing total hip arthroplasty: a retrospective cohort study. BMJ Open 2016; 6:e010664. [PMID: 27130165 PMCID: PMC4853994 DOI: 10.1136/bmjopen-2015-010664] [Citation(s) in RCA: 146] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 03/17/2016] [Accepted: 03/23/2016] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To determine chronic opioid use pre-THA (total hip arthroplasty) and post-THA, and risk factors for persistent or new chronic opioid use post-THA. DESIGN Retrospective cohort study. SETTING Australian Government Department of Veterans' Affairs health claims database. PARTICIPANTS 9525 patients who had an elective unilateral THA between 1/01/2001 and 12/31/2012. PRIMARY OUTCOME MEASURE Chronic opioid use. Defined as 90 days of continuous opioid use or 120 days of non-continuous use. RESULTS Pre-THA, 6.2% (n=593) of patients were chronic users, while 5.2% (n=492) were post-THA. Among the 492 postoperative chronic users, 302 (61%) were chronic users pre-THA and post-THA and 190 (39%) became new chronic users after surgery. Risk factors for persistent chronic use were younger age (OR=0.96, 95% CI 0.93 to 0.99/1-year increment), back pain (OR=1.99, 95% CI 1.20 to 3.23), diabetes (OR=3.52, 95% CI 1.05 to 11.8), hypnotics use (OR=2.52, 95% CI 1.48 to 4.30) and higher pre-THA opioid exposure (compared with opioid use for 94-157 days, 157-224 days (OR=3.75, 95% CI 2.28 to 6.18), 225+ days (OR=5.18, 95% CI 2.92 to 9.19). Risk factors for new chronic opioid use post-THA were being a woman (OR=1.40, 95% CI 1.00 to 1.96), back pain (OR=3.90, 95% CI 2.85 to 5.33), depression (OR=1.70, 95% CI 1.20 to 2.41), gastric acid disease (OR=1.62, 95% CI 1.16 to 2.25), migraine (OR=5.11, 95% CI 1.08 to 24.18), liver disease (OR=4.33, 95% CI 1.08 to 17.35), weight loss (OR=2.60, 95% CI 1.06 to 6.39), dementia (OR=2.19, 95% CI 1.04 to 4.61), hyperlipidaemia (OR=1.38, 95% CI 1.00 to 1.91), hypnotics (OR=1.56, 95% CI 1.13 to 2.16) and antineuropathic pain medication use (OR=3.11, 95% CI 2.05 to 4.72). CONCLUSIONS Patients undergoing THA are exposed to opioids for long periods of time, putting them at high risk of harm related to opioid use. We identified groups at risk of chronic opioid use, including younger patients and women, as well as modifiable risk factors of chronic opioid use, including level of opioid exposure presurgery and hypnotic use. These indicators of chronic opioid use can be used by clinicians to target patient groups for suitable pain management interventions.
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Affiliation(s)
- Maria C S Inacio
- Medicine and Device Surveillance Centre of Research Excellence, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Craig Hansen
- Medicine and Devices Surveillance Centre of Research Excellence, School of Pharmacy and Medical Sciences, University of South Australia, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Nicole L Pratt
- Medicine and Device Surveillance Centre of Research Excellence, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Stephen E Graves
- Australian Orthopaedic Association National Total Joint Replacement Registry, University of Adelaide, Adelaide, South Australia, Australia
| | - Elizabeth E Roughead
- Medicine and Device Surveillance Centre of Research Excellence, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
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Bech NH, Kodde IF, Dusseldorp F, Druyts PAMC, Jansen SPL, Haverkamp D. Hip arthroscopy in obese, a successful combination? J Hip Preserv Surg 2015; 3:37-42. [PMID: 27026817 PMCID: PMC4808258 DOI: 10.1093/jhps/hnv076] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 09/01/2015] [Accepted: 10/25/2015] [Indexed: 11/19/2022] Open
Abstract
Discussion persists about the outcome and results of hip arthroscopy in obese patients. Hip arthroscopy gained popularity over time. A current discussion is if obese patients can reach similar results after surgery compared with non-obese. To our knowledge, this is the first systematic review of literature about hip arthroscopy and obesity. We searched the Pubmed/Medline databases for literature and included three studies that compared the outcome of hip arthroscopy between different BMI groups. We extracted and pooled the data. For continues data a weighted mean difference was calculated, for dichotomous variables a weighted odds ratio (OR) was calculated using Review Software Manager. Heterogeneity of the included studies was calculated using I2 statistics. Data were extracted from two studies. In the Obese group, there was significant more conversion to total hip replacement or resurfacing hip replacement (OR = 2.21, 95% CI 1.07–4.56) and more re-arthroscopy (OR = 4.68, 95% CI 1.41–15.45). Any reoperation occurred more often in the obese group (OR = 2.87, 95% CI 1.53–5.38). In the Non Arthritic Hip Score obese scored lower than the non-Obese group [10.9 (−14,6 to 7.1)]. For the modified Harris Hip Score the score is − 6,6, according to the MCID this difference is clinically relevant. For both scores obese show lower outcomes but similar improvement after hip arthroscopy. Regarding a higher chance of needing a re-operation and lower subjective outcome scores obesity appears to have a negative influence on the outcome of hip arthroscopy.
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Affiliation(s)
- N H Bech
- 1. Department of Orthopedic Surgery, Slotervaart Medical Center, Louwesweg 6, Amsterdam 1066 EC, the Netherlands
| | - I F Kodde
- 1. Department of Orthopedic Surgery, Slotervaart Medical Center, Louwesweg 6, Amsterdam 1066 EC, the Netherlands
| | - F Dusseldorp
- 1. Department of Orthopedic Surgery, Slotervaart Medical Center, Louwesweg 6, Amsterdam 1066 EC, the Netherlands
| | - P A M C Druyts
- 2. Department of Orthopedic Surgery, TweeSteden Hospital, Dr Deelenlaan 5, Tilburg 5042 AD, the Netherlands
| | - S P L Jansen
- 3. Department of Orthopedic Surgery, Rijnland Hospital, Simon Smitweg 1, Leiderdorp 2353 GA, the Netherland
| | - D Haverkamp
- 1. Department of Orthopedic Surgery, Slotervaart Medical Center, Louwesweg 6, Amsterdam 1066 EC, the Netherlands
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