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Cassidy DE, Shao Z, Howard R, Englesbe MJ, Dimick JB, Telem DA, Ehlers AP. Variability in surgical approaches to hernias in patients with ascites. Surg Endosc 2024; 38:735-741. [PMID: 38049668 DOI: 10.1007/s00464-023-10598-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 11/14/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND Hernias in patients with ascites are common, however we know very little about the surgical repair of hernias within this population. The study of these repairs has largely remained limited to single center and case studies, lacking a population-based study on the topic. STUDY DESIGN The Michigan Surgical Quality Collaborative and its corresponding Core Optimization Hernia Registry (MSQC-COHR) which captures specific patient, hernia, and operative characteristics at a population level within the state was used to conduct a retrospective review of patients with ascites undergoing ventral or inguinal hernia repair between January 1, 2020 and May 3, 2022. The primary outcome observed was incidence and surgical approach for both ventral and inguinal hernia cohorts. Secondary outcomes included 30-day adverse clinical outcomes as listed here: (ED visits, readmission, reoperation and complications) and surgical priority (urgent/emergent vs elective). RESULTS In a cohort of 176 patients with ascites, surgical repair of hernias in patients with ascites is a rare event (1.4% in ventral hernia cohort, 0.2% in inguinal hernia cohort). The post-operative 30-day adverse clinical outcomes in both cohorts were greatly increased compared to those without ascites (ventral: 32% inguinal: 30%). Readmission was the most common complication in both inguinal (n = 14, 15.9%) and ventral hernia (n = 17, 19.3%) groups. Although open repair was most common for both cohorts (ventral: 86%, open: 77%), minimally invasive (MIS) approaches were utilized. Ventral hernias presented most commonly urgently/emergently (60%), and in contrast many inguinal hernias presented electively (72%). CONCLUSION A population-level, ventral and incisional hernia database capturing operative details for 176 patients with ascites. There was variation in the surgical approaches performed for this rare event and opportunities for optimization in patient selection and timing of repair.
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Affiliation(s)
- Devon E Cassidy
- University of Michigan Medical School, 1500 E Medical Center Dr., Ann Arbor, MI, USA.
| | - Zhihong Shao
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Ryan Howard
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | | | - Justin B Dimick
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Dana A Telem
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Anne P Ehlers
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
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Farjo R, Hu HM, Waljee JF, Englesbe MJ, Brummett CM, Bicket MC. Comparison of methods to identify individuals prescribed opioid analgesics for pain. Reg Anesth Pain Med 2024:rapm-2023-105164. [PMID: 38272570 DOI: 10.1136/rapm-2023-105164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/04/2024] [Indexed: 01/27/2024]
Abstract
INTRODUCTION While identifying opioid prescriptions in claims data has been instrumental in informing best practises, studies have not evaluated whether certain methods of identifying opioid prescriptions yield better results. We compared three common approaches to identify opioid prescriptions in large, nationally representative databases. METHODS We performed a retrospective cohort study, analyzing MarketScan, Optum, and Medicare claims to compare three methods of opioid classification: claims database-specific classifications, National Drug Codes (NDC) from the Centers for Disease Control and Prevention (CDC), or NDC from Overdose Prevention Engagement Network (OPEN). The primary outcome was discrimination by area under the curve (AUC), with secondary outcomes including the number of opioid prescriptions identified by experts but not identified by each method. RESULTS All methods had high discrimination (AUC>0.99). For MarketScan (n=70,162,157), prescriptions that were not identified totalled 42,068 (0.06%) for the CDC list, 2,067,613 (2.9%) for database-specific categories, and 0 (0%) for the OPEN list. For Optum (n=61,554,852), opioid prescriptions not identified totalled 9,774 (0.02%) for the CDC list, 83,700 (0.14%) for database-specific categories, and 0 (0%) for the OPEN list. In Medicare claims (n=92,781,299), the number of opioid prescriptions not identified totalled 8,694 (0.01%) for the CDC file and 0 (0%) for the OPEN list. DISCUSSION This analysis found that identifying opioid prescriptions using methods from CDC and OPEN were similar and superior to prespecified database-specific categories. Overall, this study shows the importance of carefully selecting the approach to identify opioid prescriptions when investigating claims data.
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Affiliation(s)
- Reem Farjo
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Hsou-Mei Hu
- Department of Anesthesiology, University of Michigan-Ann Arbor, Ann Arbor, Michigan, USA
- Overdose Prevention Engagement Network, Institute for Healthcare Policy and Innovation, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Jennifer F Waljee
- Overdose Prevention Engagement Network, Institute for Healthcare Policy and Innovation, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
- Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Michael J Englesbe
- Overdose Prevention Engagement Network, Institute for Healthcare Policy and Innovation, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
- Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Chad M Brummett
- Department of Anesthesiology, University of Michigan-Ann Arbor, Ann Arbor, Michigan, USA
- Overdose Prevention Engagement Network, Institute for Healthcare Policy and Innovation, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Mark C Bicket
- Department of Anesthesiology, University of Michigan-Ann Arbor, Ann Arbor, Michigan, USA
- Overdose Prevention Engagement Network, Institute for Healthcare Policy and Innovation, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
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Song J, Li Y, Waljee JF, Gunaseelan V, Brummett CM, Englesbe MJ, Bicket MC. What evidence is needed to inform postoperative opioid consumption guidelines? A cohort study of the Michigan Surgical Quality Collaborative. Reg Anesth Pain Med 2024; 49:23-29. [PMID: 37247946 PMCID: PMC10684823 DOI: 10.1136/rapm-2023-104581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 05/18/2023] [Indexed: 05/31/2023]
Abstract
INTRODUCTION To balance adequate pain management while minimizing opioid-related harms after surgery, opioid prescribing guidelines rely on patient-reported use after surgery. However, it is unclear how many patients are required to develop precise guidelines. We aimed to compare patterns of use, required sample size, and the precision for patient-reported opioid consumption after common surgical procedures. METHODS We analyzed procedure-specific 30-day opioid consumption data reported after discharge from 15 common surgical procedures between January 2018 and May 2019 across 65 hospitals in the Michigan Surgical Quality Collaborative. We calculated proportions of patients using no pills and the estimated number of pills meeting most patients' needs, defined as the 75th percentile of consumption. We compared several methods to model consumption patterns. Using the best method (Tweedie), we calculated sample sizes required to identify opioid consumption within a 5-pill interval and estimates of pills to meet most patients' needs by calculating the width of 95% CIs. RESULTS In a cohort of 10,688 patients, many patients did not consume any opioids after all types of procedures (range 20%-40%). Most patients' needs were met with 4 pills (thyroidectomy) to 13 pills (abdominal hysterectomy). Sample sizes required to estimate opioid consumption within a 5-pill wide 95% CI ranged from 48 for laparoscopic appendectomy to 188 for open colectomy. The 95% CI width for estimates ranged from 0.7 pills for laparoscopic cholecystectomy to 7.0 pills for ileostomy/colostomy. CONCLUSIONS This study demonstrates that profiles of opioid consumption share more similarities than differences for certain surgical procedures. Future investigations on patient-reported consumption are required for procedures not currently included in prescribing guidelines to ensure surgeons and perioperative providers can appropriately tailor recommendations to the postoperative needs of patients.
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Affiliation(s)
- Jiyeon Song
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Yi Li
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Jennifer F Waljee
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
- Opioid Prescribing Engagement Network, Institute for Health Policy and Innovation, Ann Arbor, MI, USA
| | - Vidhya Gunaseelan
- Opioid Prescribing Engagement Network, Institute for Health Policy and Innovation, Ann Arbor, MI, USA
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Chad M Brummett
- Opioid Prescribing Engagement Network, Institute for Health Policy and Innovation, Ann Arbor, MI, USA
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael J Englesbe
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
- Opioid Prescribing Engagement Network, Institute for Health Policy and Innovation, Ann Arbor, MI, USA
| | - Mark C Bicket
- Opioid Prescribing Engagement Network, Institute for Health Policy and Innovation, Ann Arbor, MI, USA
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
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O'Neill SM, Fry BT, Weng W, Rubyan M, Howard RA, Ehlers AP, Englesbe MJ, Dimick JB, Telem DA. Use of statewide financial incentives to improve documentation of hernia and mesh characteristics in ventral hernia repair. Surg Endosc 2024; 38:414-418. [PMID: 37821560 DOI: 10.1007/s00464-023-10498-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 09/24/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Documentation of intraoperative details is critical for understanding and advancing hernia care, but is inconsistent in practice. Therefore, to improve data capture on a statewide level, we implemented a financial incentive targeting documentation of hernia defect size and mesh use. METHODS The Abdominal Hernia Care Pathway (AHCP), a voluntary pay for performance (P4P) initiative, was introduced in 2021 within the statewide Michigan Surgical Quality Collaborative (MSQC). This consisted of an organizational-level financial incentive for achieving 80% performance on eight specific process measures for ventral hernia surgery, including complete documentation of hernia defect size and location, as well as mesh characteristics and fixation technique. Comparisons were made between AHCP and non-AHCP sites in 2021. RESULTS Of 69 eligible sites, 47 participated in the AHCP in 2021. There were N = 5362 operations (4169 at AHCP sites; 1193 at non-AHCP sites). At AHCP sites, 69.8% of operations had complete hernia documentation, compared to 50.5% at non-AHCP sites (p < 0.0001). At AHCP sites, 91.4% of operations had complete mesh documentation, compared to 86.5% at non-AHCP sites (p < 0.0001). The site-level hernia documentation goal of 80% was reached by 14 of 47 sites (range 14-100%). The mesh documentation goal was reached by 41 of 47 sites (range 4-100%). CONCLUSIONS Addition of an organizational-level financial incentive produced marked gains in documentation of intra-operative details across a statewide surgical collaborative. The relatively large effect size-19.3% for hernia-is remarkable among P4P initiatives. This result may have been facilitated by surgeons' direct role in documenting hernia size and mesh use. These improvements in data capture will foster understanding of current hernia practices on a large scale and may serve as a model for improvement in collaboratives nationally.
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Affiliation(s)
- Sean M O'Neill
- Department of Surgery, Michigan Medicine, University of Michigan, Taubman Center, TC 2924B, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA.
| | - Brian T Fry
- Department of Surgery, Michigan Medicine, University of Michigan, Taubman Center, TC 2924B, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Wenjing Weng
- Michigan Surgical Quality Collaborative, Ann Arbor, MI, USA
| | - Michael Rubyan
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
- University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Ryan A Howard
- Department of Surgery, Michigan Medicine, University of Michigan, Taubman Center, TC 2924B, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Anne P Ehlers
- Department of Surgery, Michigan Medicine, University of Michigan, Taubman Center, TC 2924B, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Michael J Englesbe
- Department of Surgery, Michigan Medicine, University of Michigan, Taubman Center, TC 2924B, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Justin B Dimick
- Department of Surgery, Michigan Medicine, University of Michigan, Taubman Center, TC 2924B, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Dana A Telem
- Department of Surgery, Michigan Medicine, University of Michigan, Taubman Center, TC 2924B, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
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McGowan JG, Martin GP, Krapohl GL, Campbell DA, Englesbe MJ, Dimick JB, Dixon-Woods M. What are the features of high-performing quality improvement collaboratives? A qualitative case study of a state-wide collaboratives programme. BMJ Open 2023; 13:e076648. [PMID: 38097243 PMCID: PMC10729078 DOI: 10.1136/bmjopen-2023-076648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 11/20/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVES Despite their widespread use, the evidence base for the effectiveness of quality improvement collaboratives remains mixed. Lack of clarity about 'what good looks like' in collaboratives remains a persistent problem. We aimed to identify the distinctive features of a state-wide collaboratives programme that has demonstrated sustained improvements in quality of care in a range of clinical specialties over a long period. DESIGN Qualitative case study involving interviews with purposively sampled participants, observations and analysis of documents. SETTING The Michigan Collaborative Quality Initiatives programme. PARTICIPANTS 38 participants, including clinicians and managers from 10 collaboratives, and staff from the University of Michigan and Blue Cross Blue Shield of Michigan. RESULTS We identified five features that characterised success in the collaboratives programme: learning from positive deviance; high-quality coordination; high-quality measurement and comparative performance feedback; careful use of motivational levers; and mobilising professional leadership and building community. Rigorous measurement, securing professional leadership and engagement, cultivating a collaborative culture, creating accountability for quality, and relieving participating sites of unnecessary burdens associated with programme participation were all important to high performance. CONCLUSIONS Our findings offer valuable learning for optimising collaboration-based approaches to improvement in healthcare, with implications for the design, structure and resourcing of quality improvement collaboratives. These findings are likely to be useful to clinicians, managers, policy-makers and health system leaders engaged in multiorganisational approaches to improving quality and safety.
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Affiliation(s)
- James G McGowan
- The Healthcare Improvement Studies Institute (THIS Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Graham P Martin
- The Healthcare Improvement Studies Institute (THIS Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Greta L Krapohl
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | | | | | - Justin B Dimick
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Mary Dixon-Woods
- The Healthcare Improvement Studies Institute (THIS Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Chua KP, Nguyen TD, Brummett CM, Bohnert AS, Gunaseelan V, Englesbe MJ, Waljee JF. Changes in Surgical Opioid Prescribing and Patient-Reported Outcomes After Implementation of an Insurer Opioid Prescribing Limit. JAMA Health Forum 2023; 4:e233541. [PMID: 37831460 PMCID: PMC10576220 DOI: 10.1001/jamahealthforum.2023.3541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 08/04/2023] [Indexed: 10/14/2023] Open
Abstract
Importance Insurers are increasingly limiting the duration of opioid prescriptions for acute pain. Among patients undergoing surgery, it is unclear whether implementation of these limits is associated with changes in opioid prescribing and patient-reported outcomes, such as pain. Objective To assess changes in surgical opioid prescribing and patient-reported outcomes after implementation of an opioid prescribing limit by a large commercial insurer in Michigan. Design, Setting, and Participants This was a cross-sectional study with an interrupted time series analysis. Data analyses were conducted from October 1, 2022, to February 28, 2023. The primary data source was the Michigan Surgical Quality Collaborative, a statewide registry containing data on opioid prescribing and patient-reported outcomes from adults undergoing common general surgical procedures. This registry is linked to Michigan's prescription drug monitoring program database, allowing observation of opioid dispensing. The study included 6045 adults who were covered by the commercial insurer and underwent surgery from January 1, 2017, to October 31, 2019. Exposure Policy limiting opioid prescriptions to a 5-day supply in February 2018. Main Outcomes and Measures Among all patients, segmented regression models were used to assess for level or slope changes during February 2018 in 3 patient-reported outcomes: pain in the week after surgery (assessed on a scale of 1-4: 1 = none, 2 = minimal, 3 = moderate, and 4 = severe), satisfaction with surgical experience (scale of 0-10, with 10 being the highest satisfaction), and amount of regret regarding undergoing surgery (scale of 1-5, with 1 being the highest level of regret). Among patients with a discharge opioid prescription and a dispensed opioid prescription (prescription filled within 3 days of discharge), additional outcomes included total morphine milligram equivalents in these prescriptions, a standardized measure of opioid volume. Results Among the 6045 patients included in the study, mean (SD) age was 48.7 (12.6) years and 3595 (59.5%) were female. Limit implementation was not associated with changes in patient-reported satisfaction or regret and was associated with only a slight level decrease in patient-reported pain score (-0.15 [95% CI, -0.26 to -0.03]). Among 4396 patients (72.7%) with a discharge and dispensed opioid prescription, limit implementation was associated with a -22.3 (95% CI, -32.8 to -11.9) and -26.1 (95% CI, -40.9 to -11.3) level decrease in monthly mean total morphine milligram equivalents of discharge and dispensed opioid prescriptions, respectively. These decreases corresponded approximately to 3 to 3.5 pills containing 5 mg of oxycodone. Conclusions This cross-sectional analysis of data from adults undergoing general surgical procedures found that implementation of an insurer's limit was associated with modest reductions in opioid prescribing but not with worsened patient-reported outcomes. Whether these findings generalize to other procedures warrants further study.
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Affiliation(s)
- Kao-Ping Chua
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan Medical School, Ann Arbor
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor
| | - Thuy D. Nguyen
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor
| | - Chad M. Brummett
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor
- Michigan Opioid Prescribing Engagement Network, University of Michigan Medical School, Ann Arbor
| | - Amy S. Bohnert
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor
| | - Vidhya Gunaseelan
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor
- Michigan Opioid Prescribing Engagement Network, University of Michigan Medical School, Ann Arbor
| | - Michael J. Englesbe
- Michigan Opioid Prescribing Engagement Network, University of Michigan Medical School, Ann Arbor
- Department of Surgery, University of Michigan Medical School, Ann Arbor
| | - Jennifer F. Waljee
- Michigan Opioid Prescribing Engagement Network, University of Michigan Medical School, Ann Arbor
- Department of Surgery, University of Michigan Medical School, Ann Arbor
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Fernandez AC, Waljee JF, Gunaseelan V, Brummett CM, Englesbe MJ, Bicket MC. Prevalence of Unhealthy Substance Use and Associated Characteristics Among Patients Presenting for Surgery. Ann Surg 2023; 278:e740-e744. [PMID: 36538617 PMCID: PMC10205913 DOI: 10.1097/sla.0000000000005767] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To assess the prevalence of and identify characteristics associated with unhealthy use before surgery. BACKGROUND Although the escalation in US drug overdose deaths is apparent, the unhealthy use of substances among patients presenting for surgery is unclear. METHODS We conducted a retrospective study of patients presenting for elective surgical procedures between December 2018 and July 2021 and prospectively recruited to 1 of 2 clinical research studies (Michigan Genomics Initiative, Prevention of Iatrogenic Opioid Dependence after Surgery Study). The primary outcome was unhealthy substance use in the past 12 months as determined using the Tobacco, Alcohol, Prescription medication, and other Substance use tool. RESULTS Among 1912 patients, unhealthy substance use was reported in 768 (40.2%). The most common substances with unhealthy use were illicit drugs [385 (20.1%)], followed by alcohol 358 (18.7%)], tobacco [262 (13.7%)], and prescription medications [86 (4.5%)]. Patients reporting unhealthy substance use were significantly more likely to be younger, male [aOR: 1.95 (95% CI, 1.58-2.42)], and have higher scores for pain [aOR: 1.07 (95% CI, 1.02-1.13)], and anxiety [aOR: 1.03 (95% CI, 1.01-1.04)]. Unhealthy substance use was more common among surgical procedures of the forearm, wrist, and hand [aOR: 2.58 (95% CI, 1.01-6.55)]. CONCLUSIONS As many as 2 in 5 patients in the preoperative period may present with unhealthy substance use before elective surgery. Given the potential impact of substance use on surgical outcomes, increased recognition of the problem by screening patients is a critical next step for surgeons and perioperative care teams.
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Affiliation(s)
- Anne C Fernandez
- Department of Psychiatry, Addiction Center, University of Michigan, Ann Arbor, MI
| | - Jennifer F Waljee
- Department of Surgery, University of Michigan, Ann Arbor, MI
- Opioid Prescribing Engagement Network, Institute for Healthcare Policy and Innovation, University of Michigan School of Public Health, University of Michigan, Ann Arbor, MI
| | - Vidhya Gunaseelan
- Opioid Prescribing Engagement Network, Institute for Healthcare Policy and Innovation, University of Michigan School of Public Health, University of Michigan, Ann Arbor, MI
| | - Chad M Brummett
- Opioid Prescribing Engagement Network, Institute for Healthcare Policy and Innovation, University of Michigan School of Public Health, University of Michigan, Ann Arbor, MI
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI
| | - Michael J Englesbe
- Department of Surgery, University of Michigan, Ann Arbor, MI
- Opioid Prescribing Engagement Network, Institute for Healthcare Policy and Innovation, University of Michigan School of Public Health, University of Michigan, Ann Arbor, MI
| | - Mark C Bicket
- Opioid Prescribing Engagement Network, Institute for Healthcare Policy and Innovation, University of Michigan School of Public Health, University of Michigan, Ann Arbor, MI
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI
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Lin VJT, Rieck H, Gunaseelan V, Wixson M, Waljee JF, Brummett CM, Englesbe MJ, Bicket MC. The acceptability and utility of opioid and other high-risk substance use screening as implemented within the perioperative workflow. Pain Med 2023; 24:1116-1118. [PMID: 37040080 PMCID: PMC10472483 DOI: 10.1093/pm/pnad046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 03/11/2023] [Accepted: 04/06/2023] [Indexed: 04/12/2023]
Affiliation(s)
- Victor J T Lin
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI 48109, United States
| | - Heidi Rieck
- Michigan Opioid Prescribing Engagement Network, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI 48109, United States
- Department of Surgery, University of Michigan, Ann Arbor, MI 48109, United States
| | - Vidhya Gunaseelan
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI 48109, United States
- Michigan Opioid Prescribing Engagement Network, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI 48109, United States
| | - Matthew Wixson
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI 48109, United States
| | - Jennifer F Waljee
- Michigan Opioid Prescribing Engagement Network, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI 48109, United States
- Department of Surgery, University of Michigan, Ann Arbor, MI 48109, United States
| | - Chad M Brummett
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI 48109, United States
- Michigan Opioid Prescribing Engagement Network, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI 48109, United States
| | - Michael J Englesbe
- Michigan Opioid Prescribing Engagement Network, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI 48109, United States
- Department of Surgery, University of Michigan, Ann Arbor, MI 48109, United States
| | - Mark C Bicket
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI 48109, United States
- Michigan Opioid Prescribing Engagement Network, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI 48109, United States
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Breuler CJ, Shabet C, Delaney LD, Brown CS, Lai YL, Brummett CM, Bicket MC, Englesbe MJ, Waljee JF, Howard RA. Prescribed Opioid Dosages, Payer Type, and Self-Reported Outcomes After Surgical Procedures in Michigan, 2018-2020. JAMA Netw Open 2023; 6:e2322581. [PMID: 37428502 DOI: 10.1001/jamanetworkopen.2023.22581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/11/2023] Open
Abstract
Importance Collaborative quality improvement (CQI) models, often supported by private payers, create hospital networks to improve health care delivery. Recently, these systems have focused on opioid stewardship; however, it is unclear whether reduction in postoperative opioid prescribing occurs uniformly across health insurance payer types. Objective To evaluate the association between insurance payer type, postoperative opioid prescription size, and patient-reported outcomes in a large statewide CQI model. Design, Setting, and Participants This retrospective cohort study used data from 70 hospitals within the Michigan Surgical Quality Collaborative clinical registry for adult patients (age ≥18 years) undergoing general, colorectal, vascular, or gynecologic surgical procedures between January 1, 2018, and December 31, 2020. Exposure Insurance type, classified as private, Medicare, or Medicaid. Main Outcomes and Measures The primary outcome was postoperative opioid prescription size in milligrams of oral morphine equivalents (OME). Secondary outcomes were patient-reported opioid consumption, refill rate, satisfaction, pain, quality of life, and regret about undergoing surgery. Results A total of 40 149 patients (22 921 [57.1%] female; mean [SD] age, 53 [17] years) underwent surgery during the study period. Within this cohort, 23 097 patients (57.5%) had private insurance, 10 667 (26.6%) had Medicare, and 6385 (15.9%) had Medicaid. Unadjusted opioid prescription size decreased for all 3 groups during the study period from 115 to 61 OME for private insurance patients, from 96 to 53 OME for Medicare patients, and from 132 to 65 OME for Medicaid patients. A total of 22 665 patients received a postoperative opioid prescription and had follow-up data for opioid consumption and refill. The rate of opioid consumption was highest among Medicaid patients throughout the study period (16.82 OME [95% CI, 12.57-21.07 OME] greater than among patients with private insurance) but increased the least over time. The odds of refill significantly decreased over time for patients with Medicaid compared with patients with private insurance (odds ratio, 0.93; 95% CI, 0.89-0.98). Adjusted refill rates for private insurance remained between 3.0% and 3.1% over the study period; adjusted refill rates among Medicare and Medicaid patients decreased from 4.7% to 3.1% and 6.5% to 3.4%, respectively, by the end of the study period. Conclusions and Relevance In this retrospective cohort study of surgical patients in Michigan from 2018 to 2020, postoperative opioid prescription size decreased across all payer types, and differences between groups narrowed over time. Although funded by private payers, the CQI model appeared to have benefitted patients with Medicare and Medicaid as well.
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Affiliation(s)
| | | | - Lia D Delaney
- Division of General Surgery, Stanford Medicine, Palo Alto, California
| | - Craig S Brown
- Department of Surgery, Michigan Medicine, Ann Arbor
- Michigan Opioid Prescribing Engagement Network, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Michigan Surgical Quality Collaborative, Ann Arbor
- Center for Health Outcomes and Policy, Michigan Medicine, Ann Arbor
| | - Yen-Ling Lai
- Department of Surgery, Michigan Medicine, Ann Arbor
- Michigan Opioid Prescribing Engagement Network, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Chad M Brummett
- Michigan Opioid Prescribing Engagement Network, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Department of Anesthesiology, Michigan Medicine, Ann Arbor
| | - Mark C Bicket
- Michigan Opioid Prescribing Engagement Network, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Department of Anesthesiology, Michigan Medicine, Ann Arbor
| | - Michael J Englesbe
- Department of Surgery, Michigan Medicine, Ann Arbor
- Division of General Surgery, Stanford Medicine, Palo Alto, California
- Michigan Opioid Prescribing Engagement Network, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Jennifer F Waljee
- Department of Surgery, Michigan Medicine, Ann Arbor
- Michigan Opioid Prescribing Engagement Network, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Center for Health Outcomes and Policy, Michigan Medicine, Ann Arbor
| | - Ryan A Howard
- Department of Surgery, Michigan Medicine, Ann Arbor
- Michigan Opioid Prescribing Engagement Network, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Center for Health Outcomes and Policy, Michigan Medicine, Ann Arbor
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Reynolds CW, Shen MR, Englesbe MJ, Kwakye G. Humility: A Revised Definition and Techniques for Integration into Surgical Education. J Am Coll Surg 2023; 236:1261-1264. [PMID: 36735639 DOI: 10.1097/xcs.0000000000000640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
| | - Mary R Shen
- the Department of Surgery, University of Michigan Medical School, Ann Arbor, MI (Shen, Englesbe, Kwakye)
| | - Michael J Englesbe
- the Department of Surgery, University of Michigan Medical School, Ann Arbor, MI (Shen, Englesbe, Kwakye)
| | - Gifty Kwakye
- the Department of Surgery, University of Michigan Medical School, Ann Arbor, MI (Shen, Englesbe, Kwakye)
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Vargas GM, Gunaseelan V, Upp L, Deans KJ, Minneci PC, Gadepalli SK, Englesbe MJ, Waljee JF, Harbaugh CM. High-risk Opioid Prescribing Associated with Postoperative New Persistent Opioid Use in Adolescents and Young Adults. Ann Surg 2023; 277:761-766. [PMID: 38011505 DOI: 10.1097/sla.0000000000005193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE In this study, we explored which postoperative opioid prescribing practices were associated with persistent opioid use among adolescents and young adults. BACKGROUND Approximately 5% of adolescents and young adults develop postoperative new persistent opioid use. The impact of physician prescribing practices on persistent use among young patients is unknown. METHODS We identified opioid-naïve patients aged 13 to 21 who underwent 1 of 13 procedures (2008-2016) and filled a perioperative opioid prescription using commercial insurance claims (Optum Deidentified Clinformatics Data Mart Database). Persistent use was defined as ≥ 1 opioid prescription fill 91 to 180 days after surgery. High-risk opioid prescribing included overlapping opioid prescriptions, co-prescribed benzodiazepines, high daily prescribed dosage, long-acting formulations, and multiple prescribers. Logistic regression modeled persistent use as a function of exposure to high-risk prescribing, adjusted for patient demographics, procedure, and comorbidities. RESULTS High-risk opioid prescribing practices increased from 34.9% to 43.5% over the study period; the largest increase was in co-prescribed benzodiazepines (24.1%-33.4%). High-risk opioid prescribing was associated with persistent use (aOR 1.235 [1.12,1.36]). Receipt of prescriptions from multiple opioid prescribers was individually associated with persistent use (aOR 1.288 [1.16,1.44]). The majority of opioid prescriptions to patients with persistent use beyond the postoperative period were from nonsurgical prescribers (79.6%). CONCLUSIONS High-risk opioid prescribing practices, particularly receiving prescriptions from multiple prescribers across specialties, were associated with a significant increase in adolescent and young adult patients' risk of persistent opioid use. Prescription drug monitoring programs may help identify young patients at risk of persistent opioid use.
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Affiliation(s)
- Gracia M Vargas
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
- Michigan Opioid Prescribing Engagement Network, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; and
| | - Vidhya Gunaseelan
- Michigan Opioid Prescribing Engagement Network, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; and
| | - Lily Upp
- Michigan Opioid Prescribing Engagement Network, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; and
| | - Katherine J Deans
- Center for Surgical Outcomes Research, the Abigail Wexner Research Institute, and the Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH
| | - Peter C Minneci
- Center for Surgical Outcomes Research, the Abigail Wexner Research Institute, and the Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH
| | - Samir K Gadepalli
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - Michael J Englesbe
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
- Michigan Opioid Prescribing Engagement Network, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; and
| | - Jennifer F Waljee
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
- Michigan Opioid Prescribing Engagement Network, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; and
| | - Calista M Harbaugh
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
- Michigan Opioid Prescribing Engagement Network, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; and
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12
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Dickerson DM, Mariano ER, Szokol JW, Harned M, Clark RM, Mueller JT, Shilling AM, Udoji MA, Mukkamala SB, Doan L, Wyatt KEK, Schwalb JM, Elkassabany NM, Eloy JD, Beck SL, Wiechmann L, Chiao F, Halle SG, Krishnan DG, Cramer JD, Ali Sakr Esa W, Muse IO, Baratta J, Rosenquist R, Gulur P, Shah S, Kohan L, Robles J, Schwenk ES, Allen BFS, Yang S, Hadeed JG, Schwartz G, Englesbe MJ, Sprintz M, Urish KL, Walton A, Keith L, Buvanendran A. Multiorganizational consensus to define guiding principles for perioperative pain management in patients with chronic pain, preoperative opioid tolerance, or substance use disorder. Reg Anesth Pain Med 2023:rapm-2023-104435. [PMID: 37185214 DOI: 10.1136/rapm-2023-104435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/12/2023] [Indexed: 05/17/2023]
Abstract
Significant knowledge gaps exist in the perioperative pain management of patients with a history of chronic pain, substance use disorder, and/or opioid tolerance as highlighted in the US Health and Human Services Pain Management Best Practices Inter-Agency Task Force 2019 report. The report emphasized the challenges of caring for these populations and the need for multidisciplinary care and a comprehensive approach. Such care requires stakeholder alignment across multiple specialties and care settings. With the intention of codifying this alignment into a reliable and efficient processes, a consortium of 15 professional healthcare societies was convened in a year-long modified Delphi consensus process and summit. This process produced seven guiding principles for the perioperative care of patients with chronic pain, substance use disorder, and/or preoperative opioid tolerance. These principles provide a framework and direction for future improvement in the optimization and care of 'complex' patients as they undergo surgical procedures.
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Affiliation(s)
- David M Dickerson
- Department of Anesthesiology, Critical Care and Pain Medicine, NorthShore University HealthSystem, Evanston, Illinois, USA
- Department of Anesthesia & Critical Care, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Edward R Mariano
- Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California, USA
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Joseph W Szokol
- Department of Anesthesiology, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Michael Harned
- Department of Anesthesiology, Division of Pain Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Randall M Clark
- American Society of Anesthesiologists, Park Ridge, Illinois, USA
| | - Jeffrey T Mueller
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Ashley M Shilling
- Department of Anesthesiology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Mercy A Udoji
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia, USA
- Atlanta VA Health Care System, Decatur, Georgia, USA
| | | | - Lisa Doan
- Department of Anesthesiology, PerioperativeCare and Pain Medicine, New York University School of Medicine, New York, New York, USA
| | - Karla E K Wyatt
- Department of Anesthesiology, Perioperativeand Pain Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Jason M Schwalb
- Department of Neurosurgery, Henry Ford Medical Group, Detroit, Michigan, USA
| | - Nabil M Elkassabany
- Department of Anesthesiology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Jean D Eloy
- Department of Anesthesiology, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Stacy L Beck
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Maternal Fetal Medicine, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
| | - Lisa Wiechmann
- Department of Surgery, NewYork-Presbyterian/Columbia University Medical Center, New York, New York, USA
| | - Franklin Chiao
- Department of Anesthesiology, Westchester Medical Center, Valhalla, New York, USA
| | - Steven G Halle
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Deepak G Krishnan
- Department of Oral & Maxillofacial Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
- Department of Oral & Maxillofacial Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - John D Cramer
- Department of Otolaryngology - Head and Neck Surgery, Wayne State University, Detroit, Michigan, USA
| | - Wael Ali Sakr Esa
- Department of Pain Management, Cleveland Clinic, Cleveland, Ohio, USA
| | - Iyabo O Muse
- Department of Anesthesiology, Montefiore Medical Center, Bronx, New York, USA
- Department of Anesthesiology, Westchester Medical Center Health Network, Valhalla, New York, USA
| | - Jaime Baratta
- Department of Anesthesiology and Perioperative Medicine, Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | | | - Padma Gulur
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Shalini Shah
- Department of Anesthesiology and Perioperative Care, University of California Irvine, Orange, California, USA
| | - Lynn Kohan
- Department of Anesthesiology, University of Virginia, Charlottesville, Virginia, USA
| | - Jennifer Robles
- Department of Urology Division of Endourology and Stone Disease, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Surgical Service, Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee, USA
| | - Eric S Schwenk
- Department of Anesthesiology and Perioperative Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Brian F S Allen
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Stephen Yang
- Department of Surgery, Division of Thoracic Surgery, Johns Hopkins Medical Institutions Campus, Baltimore, Maryland, USA
| | | | - Gary Schwartz
- AABP Integrative Pain Care, Melville, New York, USA
- Maimonides Medical Center, Brooklyn, New York, USA
| | | | - Michael Sprintz
- Sprintz Center for Pain and Recovery, Shenandoah, Texas, USA
| | - Kenneth L Urish
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ashley Walton
- American Society of Anesthesiologists, Washington, District of Columbia, USA
| | - Lauren Keith
- American Society of Anesthesiologists, Park Ridge, Illinois, USA
| | - Asokumar Buvanendran
- Department of Anesthesiology, Rush University Medical Center, Chicago, Illinois, USA
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13
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Bamdad MC, Vitous CA, Rivard SJ, Anderson M, Lussiez A, De Roo A, Englesbe MJ, Suwanabol PA. What We Talk About When We Talk About Coping: A Qualitative Study of Surgery Residents' Coping following Complications and Deaths. Ann Surg 2023:00000658-990000000-00414. [PMID: 36994739 PMCID: PMC10363203 DOI: 10.1097/sla.0000000000005854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
OBJECTIVE To explore how surgery residents cope with unwanted patient outcomes including post-operative complications and death. SUMMARY BACKGROUND DATA Surgery residents face a variety of work-related stressors that require them to engage coping strategies. Post-operative complications and deaths are a common source of such stressors. While few studies examine the response to these events and their impacts on subsequent decision-making, there has been little scholarly work exploring coping strategies among surgery residents specifically. METHODS This study investigated the ways in which general surgery residents cope with unwanted patient outcomes, including complications and deaths. Mid-level and senior residents (n=28) from 14 academic, community, and hybrid training programs across the United States participated in exploratory semi-structured interviews conducted by an experienced anthropologist. Interview transcripts were analyzed iteratively, informed by thematic analysis. RESULTS When discussing how they cope with complications and deaths, residents described both internal and external strategies. Internal strategies included a sense of inevitability, compartmentalization of emotions or experiences, thoughts of forgiveness, and beliefs surrounding resilience. External strategies included support from colleagues and mentors, commitment to change, and personal practices or rituals, such as exercise or psychotherapy. CONCLUSIONS In this novel qualitative study, general surgery residents described the coping strategies that they organically employed following post-operative complications and deaths. In order to improve resident well-being, it is critical to first understand the natural coping processes. Such efforts will facilitate structuring future support systems to aid residents during these difficult periods.
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Affiliation(s)
- Michaela C Bamdad
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
- Department of Surgery, University of Michigan, Ann Arbor
| | - C Ann Vitous
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
- Department of Surgery, University of Michigan, Ann Arbor
| | - Samantha J Rivard
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
- Department of Surgery, University of Michigan, Ann Arbor
| | - Maia Anderson
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
- Department of Surgery, University of Michigan, Ann Arbor
| | - Alisha Lussiez
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
- Department of Surgery, University of Michigan, Ann Arbor
| | - Ana De Roo
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
- Department of Surgery, University of Michigan, Ann Arbor
| | - Michael J Englesbe
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
- Department of Surgery, University of Michigan, Ann Arbor
| | - Pasithorn A Suwanabol
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
- Department of Surgery, University of Michigan, Ann Arbor
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Kamyszek RW, Sood SL, Sonnenday CJ, Parikh ND, Westman A, Englesbe MJ, Waits SA, Barrett M, Fontana RJ, Kumar SS. Successful living donor liver transplantation in a patient with hemophilia A and factor VIII inhibitor: a case report with perioperative recommendations. Am J Transplant 2023:S1600-6135(23)00311-8. [PMID: 36898636 DOI: 10.1016/j.ajt.2023.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/27/2023] [Accepted: 02/27/2023] [Indexed: 03/11/2023]
Abstract
Liver transplantation in patients with end-stage liver disease and coexisting hemophilia A has been described. Controversy exists over perioperative management of patients with factor VIII inhibitor predisposing patients to hemorrhage. We describe the case of a 58-year-old man with a history of hemophilia A and factor VIII inhibitor, eradicated with rituximab prior to living donor liver transplantation without recurrence of inhibitor. We also provide perioperative management recommendations from our successful multidisciplinary approach.
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Affiliation(s)
- Reed W Kamyszek
- Department of Anesthesiology, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Suman L Sood
- Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan, USA
| | | | - Neehar D Parikh
- Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Amanda Westman
- Department of Anesthesiology, Michigan Medicine, Ann Arbor, Michigan, USA; Anesthesia Practice Consultants, P.C. Grand Rapids, Michigan, USA
| | | | - Seth A Waits
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Meredith Barrett
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Robert J Fontana
- Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Sathish S Kumar
- Department of Anesthesiology, Michigan Medicine, Ann Arbor, Michigan, USA.
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15
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Simha S, Ahmed Y, Brummett CM, Waljee JF, Englesbe MJ, Bicket MC. Impact of the COVID-19 pandemic on opioid overdose and other adverse events in the USA and Canada: a systematic review. Reg Anesth Pain Med 2023; 48:37-43. [DOI: 10.1136/rapm-2022-103591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 09/07/2022] [Indexed: 02/19/2023]
Abstract
ImportanceThe COVID-19 pandemic impacted healthcare beyond COVID-19 infections. A better understanding of how COVID-19 worsened the opioid crisis has potential to inform future response efforts.ObjectiveTo summarize changes from the COVID-19 pandemic on outcomes regarding opioid use and misuse in the USA and Canada.Evidence reviewWe searched MEDLINE via PubMed, EMBASE, and CENTRAL for peer-reviewed articles published between March 2020 and December 2021 that examined outcomes relevant to patients with opioid use, misuse, and opioid use disorder by comparing the period before vs after COVID-19 onset in the USA and Canada. Two reviewers independently screened studies, extracted data, assessed methodological quality and bias via Newcastle-Ottawa Scale, and synthesized results.FindingsAmong 20 included studies, 13 (65%) analyzed service utilization, 6 (30%) analyzed urine drug testing results, and 2 (10%) analyzed naloxone dispensation. Opioid-related emergency medicine utilization increased in most studies (85%, 11/13) for both service calls (17% to 61%) and emergency department visits (42% to 122%). Urine drug testing positivity results increased in all studies (100%, 6/6) for fentanyl (34% to 138%), most (80%, 4/5) studies for heroin (-12% to 62%), and most (75%, 3/4) studies for oxycodone (0% to 44%). Naloxone dispensation was unchanged and decreased in one study each.InterpretationSignificant increases in surrogate measures of the opioid crisis coincided with the onset of COVID-19. These findings serve as a call to action to redouble prevention, treatment, and harm reduction efforts for the opioid crisis as the pandemic evolves.PROSPERO registration numberCRD42021236464.
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Abstract
OBJECTIVE To evaluate the association between postoperative opioid prescription size and patient-reported satisfaction among surgical patients. SUMMARY BACKGROUND DATA Opioids are overprescribed after surgery, which negatively impacts patient outcomes. The assumption that larger prescriptions increase patient satisfaction has been suggested as an important driver of excessive prescribing. METHODS This prospective cohort study evaluated opioid-naive adult patients undergoing laparoscopic cholecystectomy, laparoscopic appendectomy, and minor hernia repair between January 1 and May 31, 2018. The primary outcome was patient satisfaction, collected via a 30-day postoperative survey. Satisfaction was measured on a scale of 0 to 10 and dichotomized into "highly satisfied" (9-10) and "not highly satisfied" (0-8). The explanatory variable of interest was size of opioid prescription at discharge from surgery, converted into milligrams of oral morphine equivalents (OME). Hierarchical logistic regression was performed to evaluate the association between prescription size and satisfaction while adjusting for clinical covariates. RESULTS One thousand five hundred twenty patients met the inclusion criteria. Mean age was 53 years and 43% of patients were female. One thousand two hundred seventy-nine (84.1%) patients were highly satisfied and 241 (15.9%) were not highly satisfied. After multivariable adjustment, there was no significant association between opioid prescription size and satisfaction (OR 1.00, 95% CI 0.99-1.00). The predicted probability of being highly satisfied ranged from 83% for the smallest prescription (25 mg OME) to 85% for the largest prescription (750 mg OME). CONCLUSIONS In a large cohort of patients undergoing common surgical procedures, there was no association between opioid prescription size at discharge after surgery and patient satisfaction. This implies that surgeons can provide significantly smaller opioid prescriptions after surgery without negatively affecting patient satisfaction.
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Affiliation(s)
- Brian T Fry
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Ryan A Howard
- Department of Surgery, University of Michigan, Ann Arbor, MI
- Michigan Opioid Prescribing Engagement Network, Ann Arbor, MI
| | - Vidhya Gunaseelan
- Department of Surgery, University of Michigan, Ann Arbor, MI
- Michigan Opioid Prescribing Engagement Network, Ann Arbor, MI
- Michigan Surgical Quality Collaborative, Ann Arbor, MI
| | - Jay S Lee
- Department of Surgery, Memorial Sloan Kettering, New York, NY
| | - Jennifer F Waljee
- Department of Surgery, University of Michigan, Ann Arbor, MI
- Michigan Opioid Prescribing Engagement Network, Ann Arbor, MI
| | - Michael J Englesbe
- Department of Surgery, University of Michigan, Ann Arbor, MI
- Michigan Opioid Prescribing Engagement Network, Ann Arbor, MI
- Michigan Surgical Quality Collaborative, Ann Arbor, MI
| | - Joceline V Vu
- Department of Surgery, University of Michigan, Ann Arbor, MI
- Michigan Opioid Prescribing Engagement Network, Ann Arbor, MI
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17
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Santosa KB, Wang CS, Hu HM, Mullen CR, Brummett CM, Englesbe MJ, Bicket MC, Myers PL, Waljee JF. Opioid Coprescribing with Sedatives after Implant-Based Breast Reconstruction. Plast Reconstr Surg 2022; 150:1224e-1235e. [PMID: 36103669 PMCID: PMC9712174 DOI: 10.1097/prs.0000000000009726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Skeletal muscle relaxants and benzodiazepines are thought to mitigate against postoperative muscle contraction. The Centers for Disease Control and Prevention and the Food and Drug Administration warn against coprescribing them with opioids because of increased risks of overdose and death. The authors evaluated the frequency of coprescribing of opioids with skeletal muscle relaxants or benzodiazepines after implant-based reconstruction. METHODS The authors examined health care claims to identify women (18 to 64 years old) who underwent implant-based breast reconstruction between January of 2008 and June of 2019 to determine the frequency of coprescribing, factors associated with coprescribing opioids and skeletal muscle relaxants or benzodiazepines, and the impact on opioid refills within 90 days of reconstruction. RESULTS A total of 86.7 percent of women ( n = 7574) who had implant-based breast reconstruction filled an opioid prescription perioperatively. Of these, 27.7 percent of women filled prescriptions for opioids and benzodiazepines, 14.4 percent for opioids and skeletal muscle relaxants, and 2.4 percent for opioids, benzodiazepines, and skeletal muscle relaxants. Risk factors for coprescribing opioids and benzodiazepines included use of acellular dermal matrix, immediate reconstruction, and history of anxiety. Women who filled prescriptions for opioids and skeletal muscle relaxants, opioids and benzodiazepines, and opioids with skeletal muscle relaxants and benzodiazepines were significantly more likely to refill opioid prescriptions, even when controlling for preoperative opioid exposure. CONCLUSIONS Nearly half of women filled an opioid prescription with a benzodiazepine, skeletal muscle relaxant, or both after implant-based breast reconstruction. Coprescribing of opioids with skeletal muscle relaxants may potentiate opioid use after surgery and should be avoided given the risks of sedation. Identifying strategies that avoid sedatives to manage pain after breast reconstruction is critical to mitigate high-risk prescribing practices. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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Affiliation(s)
- Katherine B. Santosa
- House Officer, Section of Plastic Surgery, Department of Surgery, University of Michigan Health System; 1500 E. Medical Center Drive, Ann Arbor, MI, USA
| | - Christine S. Wang
- House Officer, Section of Plastic Surgery, Department of Surgery, University of Michigan Health System; 1500 E. Medical Center Drive, Ann Arbor, MI, USA
| | - Hsou-Mei Hu
- Analyst, Michigan Opioid Prescribing Engagement Network (Michigan OPEN), University of Michigan Health System; 1500 E. Medical Center Drive, Ann Arbor, MI, USA
| | - Connor R. Mullen
- House Officer, Section of Plastic Surgery, Department of Surgery, University of Michigan Health System; 1500 E. Medical Center Drive, Ann Arbor, MI, USA
| | - Chad M. Brummett
- Professor, Division of Pain Research, Department of Anesthesiology, University of Michigan Health System; 1500 E. Medical Center Drive, Ann Arbor, MI, USA
| | - Michael J. Englesbe
- Professor of Surgery, Section of Transplantation, Department of Surgery, University of Michigan Health System; 1500 E. Medical Center Drive, Ann Arbor, MI, USA
| | - Mark C. Bicket
- Assistant Professor, Division of Pain Research, Department of Anesthesiology University of Michigan Health System; 1500 E. Medical Center Drive, Ann Arbor, MI, USA
| | - Paige L. Myers
- Assistant Professor, Section of Plastic Surgery, Department of Surgery, University Michigan Health System; 1500 E. Medical Center Drive, Ann Arbor, MI, USA
| | - Jennifer F. Waljee
- Associate Professor, Section of Plastic Surgery, Department of Surgery, University of Michigan Health System; 1500 E. Medical Center Drive, Ann Arbor, MI, USA
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18
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Simha S, Ahmed Y, Brummett CM, Waljee JF, Englesbe MJ, Bicket MC. Impact of the COVID-19 pandemic on opioid overdose and other adverse events in the USA and Canada: a systematic review. Reg Anesth Pain Med 2022:rapm-2022-104169. [PMID: 36427903 DOI: 10.1136/rapm-2022-104169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 11/07/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Siddartha Simha
- Anesthesiology, University of Michigan Michigan Medicine, Ann Arbor, Michigan, USA
| | - Yusuf Ahmed
- University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Chad M Brummett
- Anesthesiology, University of Michigan Michigan Medicine, Ann Arbor, Michigan, USA
- Michigan Opioid Prescribing Engagement Network, Ann Arbor, Michigan, USA
| | - Jennifer F Waljee
- Michigan Opioid Prescribing Engagement Network, Ann Arbor, Michigan, USA
- Surgery, University of Michigan Michigan Medicine, Ann Arbor, Michigan, USA
| | - Michael J Englesbe
- Michigan Opioid Prescribing Engagement Network, Ann Arbor, Michigan, USA
- Surgery, University of Michigan Michigan Medicine, Ann Arbor, Michigan, USA
| | - Mark C Bicket
- Anesthesiology, University of Michigan Michigan Medicine, Ann Arbor, Michigan, USA
- Michigan Opioid Prescribing Engagement Network, Ann Arbor, Michigan, USA
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19
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Abstract
Background
Atherectomy has become the fastest growing catheter‐based peripheral vascular intervention performed in the United States, and overuse has been linked to increased reimbursement, but the patterns of use have not been well characterized.
Methods and Results
We used Blue Cross Blue Shield of Michigan Preferred Provider Organization and Medicare fee‐for‐service professional claims data from the Michigan Value Collaborative for patients undergoing office‐based laboratory atherectomy in 2019 to calculate provider‐specific rates of atherectomy use, reimbursement, number of vessels treated, and number of atherectomies per patient. We also calculated the rate that each provider converted a new patient visit to an endovascular procedure within 90 days. Correlations between parameters were assessed with simple linear regression. Providers completing ≥20 office‐based laboratory atherectomies and ≥20 new patient evaluations during the study period were included. A total of 59 providers performing 4060 office‐based laboratory atherectomies were included. Median professional reimbursement per procedure was $4671.56 (interquartile range [IQR], $2403.09–$7723.19) from Blue Cross Blue Shield of Michigan and $14 854.49 (IQR, $9414.80–$18 816.33) from Medicare, whereas total professional reimbursement from both payers ranged from $2452 to $6 880 402 per year. Median 90‐day conversion rate was 5.0% (IQR, 2.5%–10.0%), whereas the median provider‐level average number of vessels treated per patient was 1.20 (IQR, 1.13–1.31) and the median provider‐level average number of treatments per patient was 1.38 (IQR, 1.26–1.63). Total annual reimbursement for each provider was directly correlated with new patient‐procedure conversion rate (
R
2
=0.47;
P
<0.001), mean number of vessels treated per patient (
R
2
=0.31;
P
<0.001), and mean number of treatments per patient (
R
2
=0.33;
P
<0.001).
Conclusions
A minority of providers perform most procedures and are reimbursed substantially more per procedure compared with most providers. Procedural conversion rate, number of vessels, and number of treatments per patient represent potential policy levers to curb overuse.
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Affiliation(s)
- Craig S. Brown
- Section of General Surgery, Department of Surgery University of Michigan Ann Arbor MI
- Center for Healthcare Outcomes and Policy Institute for Healthcare Policy and Innovation University of Michigan Ann Arbor MI
| | - Ryan E. Eton
- Section of General Surgery, Department of Surgery University of Michigan Ann Arbor MI
- Center for Healthcare Outcomes and Policy Institute for Healthcare Policy and Innovation University of Michigan Ann Arbor MI
| | - Jessica M. Yaser
- Center for Healthcare Outcomes and Policy Institute for Healthcare Policy and Innovation University of Michigan Ann Arbor MI
| | - John D. Syrjamaki
- Center for Healthcare Outcomes and Policy Institute for Healthcare Policy and Innovation University of Michigan Ann Arbor MI
| | - Matthew A. Corriere
- Center for Healthcare Outcomes and Policy Institute for Healthcare Policy and Innovation University of Michigan Ann Arbor MI
- Section of Vascular Surgery, Department of Surgery University of Michigan Ann Arbor MI
| | - Peter K. Henke
- Section of Vascular Surgery, Department of Surgery University of Michigan Ann Arbor MI
| | - Michael J. Englesbe
- Section of General Surgery, Department of Surgery University of Michigan Ann Arbor MI
- Center for Healthcare Outcomes and Policy Institute for Healthcare Policy and Innovation University of Michigan Ann Arbor MI
| | - Nicholas H. Osborne
- Center for Healthcare Outcomes and Policy Institute for Healthcare Policy and Innovation University of Michigan Ann Arbor MI
- Section of Vascular Surgery, Department of Surgery University of Michigan Ann Arbor MI
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20
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Anderson MS, Taylor C, Englesbe MJ. From Survival to Survivorship in Pediatric Liver Transplantation. Pediatrics 2022; 150:189500. [PMID: 36111448 DOI: 10.1542/peds.2022-057753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/23/2022] [Indexed: 11/24/2022] Open
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21
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Bamdad MC, Vitous CA, Rivard SJ, Anderson M, Lussiez A, De Roo AC, Englesbe MJ, Suwanabol PA. The Best Gift You Could Give a Resident: A Qualitative Study of Well-Being Resources and Use Following Unwanted Outcomes. Ann Surg Open 2022; 3:e139. [PMID: 36936721 PMCID: PMC10013169 DOI: 10.1097/as9.0000000000000139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 01/31/2022] [Indexed: 11/26/2022] Open
Abstract
In recent years, there has been increasing focus on the well-being of resident physicians. Considering the persistent problem of burnout and attrition particularly among surgical trainees, this is a well-warranted and laudable area of focus. However, despite the widespread adoption of resources available to residents through individual institutions, there is little understanding of how and why these resources are engaged or not during particularly vulnerable moments, such as following an unwanted patient event including postoperative complications and deaths. Methods This qualitative study explored access to and usage of resources to promote well-being following an unwanted patient outcome through semi-structured interviews of 28 general surgery residents from 14 residency programs across the United States, including community, academic, and hybrid programs. A qualitative descriptive approach was used to analyze transcripts. Results Residents described 3 main types of institutional resources available to them to promote well-being, including counseling services, support from program leadership, and wellness committees. Residents also described important barriers to use for each of these resources, which limited their access and value of these resources. Finally, residents shared their recommendations for future initiatives, including additional protected time off during weekdays and regular usage of structured debrief sessions following adverse patient outcomes. Conclusions While institutional resources are commonly available to surgery residents, there remain important limitations and barriers to use, which may limit their effectiveness in supporting resident well-being in times of need. These barriers should be addressed at the program level to improve services and accessibility for residents.
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Affiliation(s)
- Michaela C. Bamdad
- From the Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | - C. Ann Vitous
- From the Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Samantha J. Rivard
- From the Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Maia Anderson
- From the Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Alisha Lussiez
- From the Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Ana C. De Roo
- From the Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Michael J. Englesbe
- From the Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Pasithorn A. Suwanabol
- From the Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
- Department of Surgery, University of Michigan, Ann Arbor, MI
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22
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Bicket MC, Gunaseelan V, Lagisetty P, Fernandez AC, Bohnert A, Assenmacher E, Sequeira M, Englesbe MJ, Brummett CM, Waljee JF. Association of opioid exposure before surgery with opioid consumption after surgery. Reg Anesth Pain Med 2022; 47:346-352. [PMID: 35241626 PMCID: PMC9035103 DOI: 10.1136/rapm-2021-103388] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 02/20/2022] [Indexed: 12/14/2022]
Abstract
ObjectiveTo determine the effect of prescription opioid use in the year before surgery on opioid consumption after surgery.BackgroundRecently developed postoperative opioid prescribing guidelines rely on data from opioid-naïve patients. However, opioid use in the USA is common, and the impact of prior opioid exposure on the consumption of opioids after surgery is unclear.MethodsPopulation-based cohort study of 26,001 adults 18 years of age and older who underwent one of nine elective general or gynecologic surgical procedures between January 1, 2017 and October 31, 2019, with prospectively collected patient-reported data from the Michigan Surgical Quality Collaborative (MSQC) linked to state prescription drug monitoring program at 70 MSQC-participating hospitals on 30-day patient-reported opioid consumption in oral morphine equivalents (OME) (primary outcome).ResultsCompared with opioid-naïve participants, opioid-exposed participants (26% of sample) consumed more prescription opioids after surgery (adjusted OME difference 12, 95% CI 10 to 14). Greater opioid exposure was associated with higher postoperative consumption in a dose-dependent manner, with chronic users reporting the greatest consumption (additional OMEs 32, 95% CI 21 to 42). However, for eight of nine procedures, 90% of opioid-exposed participants consumed ≤150 OMEs. Among those receiving perioperative prescriptions, opioid-exposed participants had higher likelihood of refill (adjusted OR 4.7, 95% CI 4.4 to 5.1), number of refills (adjusted incidence rate ratio 4.0, 95% CI 3.7 to 4.3), and average refill amount (adjusted OME difference 333, 95% CI 292 to 374)).ConclusionsPreoperative opioid use is associated with small increases in patient-reported opioid consumption after surgery for most patients, though greater differences exist for patients with chronic use. For most patients with preoperative opioid exposure, existing guidelines may meet their postoperative needs. However, guidelines may need tailoring for patients with chronic use, and providers should anticipate a higher likelihood of postoperative refills for all opioid-exposed patients.
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Affiliation(s)
- Mark C Bicket
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
- Opioid Prescribing Engagement Network, Institute for Healthcare Innovation and Policy, University of Michigan, Ann Arbor, Michigan, USA
| | - Vidhya Gunaseelan
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
- Opioid Prescribing Engagement Network, Institute for Healthcare Innovation and Policy, University of Michigan, Ann Arbor, Michigan, USA
| | - Pooja Lagisetty
- Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA
- Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan, USA
| | - Anne C Fernandez
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Amy Bohnert
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
- Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan, USA
| | | | - Melwyn Sequeira
- Department of Surgery, MidMichigan Medical Center, Midland, Texas, USA
| | - Michael J Englesbe
- Opioid Prescribing Engagement Network, Institute for Healthcare Innovation and Policy, University of Michigan, Ann Arbor, Michigan, USA
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Chad M Brummett
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
- Opioid Prescribing Engagement Network, Institute for Healthcare Innovation and Policy, University of Michigan, Ann Arbor, Michigan, USA
| | - Jennifer F Waljee
- Opioid Prescribing Engagement Network, Institute for Healthcare Innovation and Policy, University of Michigan, Ann Arbor, Michigan, USA
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
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23
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Jacobson CE, Heximer A, Olmeda-Barrientos R, Anderson MS, Waits SA, Englesbe MJ, Valbuena VSM. Language Accessibility of Liver Transplantation Center Websites. Liver Transpl 2022; 28:722-724. [PMID: 34704660 DOI: 10.1002/lt.26343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/15/2021] [Accepted: 10/18/2021] [Indexed: 01/06/2023]
Affiliation(s)
| | | | | | - Maia S Anderson
- Department of Surgery, University of Michigan, Ann Arbor, MI.,Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
| | - Seth A Waits
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | | | - Valeria S M Valbuena
- Department of Surgery, University of Michigan, Ann Arbor, MI.,Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI.,National Clinician Scholars Program, University of Michigan, Ann Arbor, MI
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24
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Abstract
BACKGROUND Complication rates after colectomy remain high. Previous work has failed to establish the relative contribution of patient comorbidities, surgeon performance, and hospital systems in the development of complications after elective colectomy. STUDY DESIGN We identified all patients undergoing elective colectomy between 2012 and 2018 at hospitals participating in the Michigan Surgical Quality Collaborative. The primary outcome was development of a postoperative complication. We used risk- and reliability-adjusted generalized linear mixed models to estimate the degree to which variance in patient-, surgeon-, and hospital-level factors contribute to complications. RESULTS A total of 15,755 patients were included in the study. The mean hospital-level complication rate was 15.8% (range, 8.7% to 30.2%). The proportion of variance attributable to the patient level was 35.0%, 2.4% was attributable to the surgeon level, and 1.8% was attributable to the hospital level. The predicted probability of complication for the least comorbid patient was 1.5% (CI 0.7-3.1%) at the highest performing hospital with the highest performing surgeon, and 6.6% (CI 3.2-12.2%) at the lowest performing hospital with the lowest performing surgeon. By contrast, the most comorbid patient in the cohort had a 66.3% (CI 39.5-85.6%) or 89.4% (CI 73.7-96.2%) risk of complication. CONCLUSIONS This study demonstrated that variance from measured factors at the patient level contributed more than 8-fold more to the development of complications after colectomy compared with variance at the surgeon and hospital level, highlighting the impact of patient comorbidities on postoperative outcomes. These results underscore the importance of initiatives that optimize patient foundational health to improve surgical care.
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Affiliation(s)
- Michaela C Bamdad
- From the Department of Surgery, University of Michigan, Ann Arbor, MI
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25
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Montgomery JR, Highet A, Brown CS, Waits SA, Englesbe MJ, Sonnenday CJ. Graft Survival and Segment Discards Among Split-Liver and Reduced-Size Transplantations in the United States From 2008 to 2018. Liver Transpl 2022; 28:247-256. [PMID: 34407278 DOI: 10.1002/lt.26271] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/08/2021] [Accepted: 08/14/2021] [Indexed: 01/13/2023]
Abstract
Split-liver transplantation has allocation advantages over reduced-size transplantation because of its ability to benefit 2 recipients. However, prioritization of split-liver transplantation relies on the following 3 major assumptions that have never been tested in the United States: similar long-term transplant recipient outcomes, lower incidence of segment discard among split-liver procurements, and discard of segments among reduced-size procurements that would be otherwise "transplantable." We used United Network for Organ Sharing Standard Transplant Analysis and Research data to identify all split-liver (n = 1831) and reduced-size (n = 578) transplantation episodes in the United States between 2008 and 2018. Multivariable Cox proportional hazards modeling was used to compare 7-year all-cause graft loss between cohorts. Secondary analyses included etiology of 30-day all-cause graft loss events as well as the incidence and anatomy of discarded segments. We found no difference in 7-year all-cause graft loss (adjusted hazard ratio [aHR], 1.1; 95% confidence interval [CI], 0.8-1.5) or 30-day all-cause graft loss (aHR, 1.1; 95% CI, 0.7-1.8) between split-liver and reduced-size cohorts. Vascular thrombosis was the most common etiology of 30-day all-cause graft loss for both cohorts (56.4% versus 61.8% of 30-day graft losses; P = 0.85). Finally, reduced-size transplantation was associated with a significantly higher incidence of segment discard (50.0% versus 8.7%) that were overwhelmingly right-sided liver segments (93.6% versus 30.3%). Our results support the prioritization of split-liver over reduced-size transplantation whenever technically feasible.
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Affiliation(s)
- John R Montgomery
- Department of Surgery, Michigan Medicine, Ann Arbor, MI.,Center for Healthcare Outcomes & Policy, Michigan Medicine, Ann Arbor, MI
| | | | - Craig S Brown
- Department of Surgery, Michigan Medicine, Ann Arbor, MI.,Center for Healthcare Outcomes & Policy, Michigan Medicine, Ann Arbor, MI
| | - Seth A Waits
- Center for Healthcare Outcomes & Policy, Michigan Medicine, Ann Arbor, MI.,Department of Surgery, Section of Transplantation, Michigan Medicine, Ann Arbor, MI
| | - Michael J Englesbe
- Center for Healthcare Outcomes & Policy, Michigan Medicine, Ann Arbor, MI.,Department of Surgery, Section of Transplantation, Michigan Medicine, Ann Arbor, MI
| | - Christopher J Sonnenday
- Center for Healthcare Outcomes & Policy, Michigan Medicine, Ann Arbor, MI.,Department of Surgery, Section of Transplantation, Michigan Medicine, Ann Arbor, MI
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26
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Anderson MS, Taylor C, Englesbe MJ. Progress in Pediatric Transplantation. Pediatrics 2022; 149:184550. [PMID: 35079815 DOI: 10.1542/peds.2021-054099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/29/2021] [Indexed: 11/24/2022] Open
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27
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Abstract
OBJECTIVE To assess the association between preoperative opioid exposure and readmissions following common surgery. SUMMARY BACKGROUND DATA Preoperative opioid use is common, but its effect on opioid-related, pain-related, respiratory-related, and all-cause readmissions following surgery is unknown. METHODS We analyzed claims data from a 20% national Medicare sample of patients ages ≥ 65 with Medicare Part D claims undergoing surgery between January 1, 2009 and November 30, 2016. We grouped patients by the dose, duration, recency, and continuity of preoperative opioid prescription fills. We used logistic regression to examine the association between prior opioid exposure and 30-day readmissions, adjusted for patient risk factors and procedure type. RESULTS Of 373,991 patients, 168,579 (45%) filled a preoperative opioid prescription within 12 months of surgery, ranging from minimal to chronic high use. Preoperative opioid exposure was associated with higher rate of opioid-related readmissions, compared with naive patients [low: aOR=1.63, 95% CI=1.26-2.12; high: aOR=3.70, 95% CI=2.71-5.04]. Preoperative opioid exposure was also associated with higher risk of pain-related readmissions [low: aOR=1.27, 95% CI=1.23-1.32; high: aOR=1.62, 95% CI=1.53-1.71] and respiratory-related readmissions [low: aOR=1.10, 95% CI=1.05-1.16; high: aOR=1.44, 95% CI=1.34-1.55]. Low, moderate, and high chronic preoperative opioid exposures were predictive of all-cause readmissions (low: OR 1.09, 95% CI: 1.06-1.12); high: OR 1.23, 95% CI: 1.18-1.29). CONCLUSIONS Higher levels of preoperative opioid exposure are associated with increased risk of readmissions after surgery. These findings emphasize the importance of screening patients for preoperative opioid exposure and creating risk mitigation strategies for patients.
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Affiliation(s)
- Ruiqi Tang
- Medical Student, University of Michigan Medical School
| | - Katherine B. Santosa
- House Officer, Section of Plastic Surgery, Department of Surgery, Michigan Medicine
| | | | - Lewei A. Lin
- Assistant Professor, Department of Psychiatry, Michigan Medicine Medicine and Research Investigator, VA Ann Arbor Healthcare System
| | - Yen-Ling Lai
- Analyst, Michigan Opioid Prescribing Engagement Network (Michigan OPEN)
| | - Michael J. Englesbe
- Darling Professor of Surgery, Section of Transplantation, Department of Surgery, Michigan Medicine
| | - Chad M. Brummett
- Associate Professor, Division of Pain Medicine, Department of Anesthesiology, Michigan Medicine
| | - Jennifer F. Waljee
- Associate Professor, Section of Plastic Surgery, Department of Surgery, Michigan Medicine
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28
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Wagner CM, Clark MJ, Theurer PF, Lall SC, Nemeh HW, Downey RS, Martin DE, Dabir RR, Asfaw ZE, Robinson PL, Harrington SD, Gandhi DB, Waljee JF, Englesbe MJ, Brummett CM, Prager RL, Likosky DS, Kim KM, Lagisetty KH, Brescia AA. Predictors of Discharge Home Without Opioids After Cardiac Surgery: A Multicenter Analysis. Ann Thorac Surg 2021; 114:2195-2201. [PMID: 34924190 DOI: 10.1016/j.athoracsur.2021.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 10/05/2021] [Accepted: 10/11/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Whether all patients will require an opioid prescription after cardiac surgery is unknown. We performed a multicenter analysis to identify patient predictors of not receiving an opioid prescription at the time of discharge home after cardiac surgery. METHODS Opioid-naïve patients undergoing coronary artery bypass grafting and/or valve surgery through a sternotomy at 10 centers from January to December 2019 were identified retrospectively from a prospectively maintained data set. Opioid-naïve was defined as not taking opioids at the time of admission. The primary outcome was discharge without an opioid prescription. Mixed-effects logistic regression was performed to identify predictors of discharge without an opioid prescription, and postdischarge opioid prescribing was monitored to assess patient tolerance of discharge without an opioid prescription. RESULTS Among 1924 eligible opioid-naïve patients, mean age was 64 ± 11 years, and 25% were women. In total, 28% of all patients were discharged without an opioid prescription. On multivariable analysis, older age, longer length of hospital stay, and undergoing surgery during the last 3 months of the study were independent predictors of discharge without an opioid prescription, whereas depression, non-Black and non-White race, and using more opioid pills on the day before discharge were independent predictors of receiving an opioid prescription. Among patients discharged without an opioid prescription, 1.8% (10 of 547) were subsequently prescribed an opioid. CONCLUSIONS Discharging select patients without an opioid prescription after cardiac surgery appears well tolerated, with a low incidence of postdischarge opioid prescriptions. Increasing the number of patients discharged without an opioid prescription may be an area for quality improvement.
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Affiliation(s)
- Catherine M Wagner
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Melissa J Clark
- Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Michigan
| | - Patricia F Theurer
- Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Michigan
| | | | | | | | | | | | | | | | | | | | - Jennifer F Waljee
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan; Department of Surgery, University of Michigan, Ann Arbor, Michigan; Michigan Opioid Prescribing Engagement Network, Ann Arbor, Michigan
| | - Michael J Englesbe
- Department of Surgery, University of Michigan, Ann Arbor, Michigan; Michigan Opioid Prescribing Engagement Network, Ann Arbor, Michigan
| | - Chad M Brummett
- Michigan Opioid Prescribing Engagement Network, Ann Arbor, Michigan; Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Richard L Prager
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan; Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Michigan
| | - Donald S Likosky
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan; Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Michigan; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan
| | - Karen M Kim
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | | | - Alexander A Brescia
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan.
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29
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Lussiez A, Anderson M, Janes L, Solano QP, Howard RA, Englesbe MJ, Suwanabol P. Differences in Decisional Regret among Patients Undergoing Elective and Non-elective Colectomy. J Am Coll Surg 2021. [DOI: 10.1016/j.jamcollsurg.2021.07.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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30
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Katzman C, Harker EC, Ahmed R, Keilin CA, Vu JV, Cron DC, Gunaseelan V, Lai YL, Brummett CM, Englesbe MJ, Waljee JF. The Association Between Preoperative Opioid Exposure and Prolonged Postoperative Use. Ann Surg 2021; 274:e410-e416. [PMID: 32427764 DOI: 10.1097/sla.0000000000003723] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the effect of nonchronic, periodic preoperative opioid use on prolonged opioid fills after surgery. BACKGROUND Nonchronic, periodic opioid use is common, but its effect on prolonged postoperative opioid fills is not well understood. We hypothesize greater periodic opioid use before surgery is correlated with persistent postoperative use. METHODS We used a national private insurance claims database, Optum's de-identifed Clinformatics Data Mart Database, to identify adults undergoing general, gynecologic, and urologic surgical procedures between 2008 and 2015 (N = 191,043). We described patterns of opioid fills based on dose, recency, duration, and continuity to categorize preoperative opioid exposure. Patients with chronic use were excluded. Our primary outcome was persistent postoperative use, defined as filling an opioid prescription between 91- and 180-days post-discharge. The association between preoperative opioid use and persistent use was determined using multivariable logistic regression, controlling for clinical covariates. RESULTS In the year before surgery, 41% of patients had nonchronic, periodic opioid fills. Compared with other risk factors, patterns of preoperative fills were most strongly correlated with persistent postoperative opioid use. Patients with recent intermittent use were significantly more likely to have prolonged fills after surgery compared with opioid-naïve patients [minimal use: odds ratio (OR): 2.0, 95% confidence interval (CI) 1.89-2.03; remote intermittent: OR 4.7, 95% CI 4.46-4.93; recent intermittent: OR 12.2, 95% CI 11.49-12.90]. CONCLUSIONS Patients with nonchronic, periodic opioid use before surgery are vulnerable to persistent postoperative opioid use. Identifying opioid use before surgery is a critical opportunity to optimize care after surgery.
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Affiliation(s)
- Charles Katzman
- University of Michigan, Department of Surgery, Ann Arbor, Michigan
| | - Emily C Harker
- University of Michigan, Department of Surgery, Ann Arbor, Michigan
| | - Rizwan Ahmed
- University of Michigan, Department of Surgery, Ann Arbor, Michigan
| | - Charles A Keilin
- University of Michigan, Department of Surgery, Ann Arbor, Michigan
| | - Joceline V Vu
- University of Michigan, Department of Surgery, Ann Arbor, Michigan
- Michigan Opioid Prescribing Engagement Network, Ann Arbor, Michigan
| | - David C Cron
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Vidhya Gunaseelan
- University of Michigan, Department of Surgery, Ann Arbor, Michigan
- Michigan Opioid Prescribing Engagement Network, Ann Arbor, Michigan
| | - Yen-Ling Lai
- University of Michigan, Department of Surgery, Ann Arbor, Michigan
| | - Chad M Brummett
- Michigan Opioid Prescribing Engagement Network, Ann Arbor, Michigan
- University of Michigan, Department of Anesthesiology, Ann Arbor, Michigan
| | - Michael J Englesbe
- University of Michigan, Department of Surgery, Ann Arbor, Michigan
- Michigan Opioid Prescribing Engagement Network, Ann Arbor, Michigan
| | - Jennifer F Waljee
- University of Michigan, Department of Surgery, Ann Arbor, Michigan
- Michigan Opioid Prescribing Engagement Network, Ann Arbor, Michigan
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Brescia AA, Clark MJ, Theurer PF, Lall SC, Nemeh HW, Downey RS, Martin DE, Dabir RR, Asfaw ZE, Robinson PL, Harrington SD, Gandhi DB, Waljee JF, Englesbe MJ, Brummett CM, Prager RL, Likosky DS, Kim KM, Lagisetty KH. Establishment and Implementation of Evidence-Based Opioid Prescribing Guidelines in Cardiac Surgery. Ann Thorac Surg 2021; 112:1176-1185. [PMID: 33285132 PMCID: PMC8550876 DOI: 10.1016/j.athoracsur.2020.11.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/13/2020] [Accepted: 11/22/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Despite the risk of new persistent opioid use after cardiac surgery, postdischarge opioid use has not been quantified and evidence-based prescribing guidelines have not been established. METHODS Opioid-naive patients undergoing primary cardiac surgery via median sternotomy between January and December 2019 at 10 hospitals participating in a statewide collaborative were selected. Clinical data were linked to patient-reported outcomes collected at 30-day follow-up. An opioid prescribing recommendation stratified by inpatient opioid use on the day before discharge (0, 1-3, or ≥4 pills) was implemented in July 2019. Interrupted time-series analyses were performed for prescription size and postdischarge opioid use before (January to June) and after (July to December) guideline implementation. RESULTS Among 1495 patients (729 prerecommendation and 766 postrecommendation), median prescription size decreased from 20 pills to 12 pills after recommendation release (P < .001), while opioid use decreased from 3 pills to 0 pills (P < .001). Change in prescription size over time was +0.6 pill/month before and -0.8 pill/month after the recommendation (difference = -1.4 pills/month; P = .036). Change in patient use was +0.6 pill/month before and -0.4 pill/month after the recommendation (difference = -1.0 pills/month; P = .017). Pain levels during the first week after surgery and refills were unchanged. Patients using 0 pills before discharge (n = 710) were prescribed a median of 0 pills and used 0 pills, while those using 1 to 3 pills (n = 536) were prescribed 20 pills and used 7 pills, and those using greater than or equal to 4 pills (n = 249) were prescribed 32 pills and used 24 pills. CONCLUSIONS An opioid prescribing recommendation was effective, and prescribing after cardiac surgery should be guided by inpatient use.
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Affiliation(s)
- Alexander A Brescia
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan.
| | - Melissa J Clark
- Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Michigan
| | - Patricia F Theurer
- Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Michigan
| | | | | | | | | | | | | | | | | | | | - Jennifer F Waljee
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan; Department of Surgery, University of Michigan, Ann Arbor, Michigan; Michigan Opioid Prescribing Engagement Network, Ann Arbor, Michigan
| | - Michael J Englesbe
- Department of Surgery, University of Michigan, Ann Arbor, Michigan; Michigan Opioid Prescribing Engagement Network, Ann Arbor, Michigan
| | - Chad M Brummett
- Michigan Opioid Prescribing Engagement Network, Ann Arbor, Michigan; Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Richard L Prager
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan; Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Michigan
| | - Donald S Likosky
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan; Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Michigan
| | - Karen M Kim
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
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Valbuena VSM, Obayemi JE, Purnell TS, Scantlebury VP, Olthoff KM, Martins PN, Higgins RS, Blackstock DM, Dick AAS, Watkins AC, Englesbe MJ, Simpson DC. Gender and racial disparities in the transplant surgery workforce. Curr Opin Organ Transplant 2021; 26:560-566. [PMID: 34524181 PMCID: PMC8524746 DOI: 10.1097/mot.0000000000000915] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW This review explores trends in the United States (US) transplant surgery workforce with a focus on historical demographics, post-fellowship job market, and quality of life reported by transplant surgeons. Ongoing efforts to improve women and racial/ethnic minority representation in transplant surgery are highlighted. Future directions to create a transplant workforce that reflects the diversity of the US population are discussed. RECENT FINDINGS Representation of women and racial and ethnic minorities among transplant surgeons is minimal. Although recent data shows an improvement in the number of Black transplant surgeons from 2% to 5.5% and an increase in women to 12%, the White to Non-White transplant workforce ratio has increased 35% from 2000 to 2013. Transplant surgeons report an average of 4.3 call nights per week and less than five leisure days a month. Transplant ranks 1st among surgical sub-specialties in the prevalence of three well-studied facets of burnout. Concerns about lifestyle may contribute to the decreasing demand for advanced training in abdominal transplantation by US graduates. SUMMARY Minimal improvements have been made in transplant surgery workforce diversity. Sustained and intentional recruitment and promotion efforts are needed to improve the representation of women and minority physicians and advanced practice providers in the field.
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Affiliation(s)
- Valeria S. M. Valbuena
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
- National Clinician Scholars Program, University of Michigan, Ann Arbor, MI, USA
| | - Joy E. Obayemi
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Tanjala S. Purnell
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Velma P. Scantlebury
- Texas Christian University and University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Kim M. Olthoff
- Department of Surgery, Division of Transplant Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Paulo N. Martins
- Department of Surgery, Division of Organ Transplantation, UMass Memorial Medical Center, University of Massachusetts, Worcester, MA, USA
| | - Robert S. Higgins
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - André A. S. Dick
- Department of Surgery, Division of Transplantation, University of Washington, Seattle, WA, USA
| | - Anthony C. Watkins
- Department of Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | | | - Dinee C. Simpson
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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33
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Mariano ER, Dickerson DM, Szokol JW, Harned M, Mueller JT, Philip BK, Baratta JL, Gulur P, Robles J, Schroeder KM, Wyatt KEK, Schwalb JM, Schwenk ES, Wardhan R, Kim TS, Higdon KK, Krishnan DG, Shilling AM, Schwartz G, Wiechmann L, Doan LV, Elkassabany NM, Yang SC, Muse IO, Eloy JD, Mehta V, Shah S, Johnson RL, Englesbe MJ, Kallen A, Mukkamala SB, Walton A, Buvanendran A. A multisociety organizational consensus process to define guiding principles for acute perioperative pain management. Reg Anesth Pain Med 2021; 47:118-127. [PMID: 34552003 DOI: 10.1136/rapm-2021-103083] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/09/2021] [Indexed: 12/22/2022]
Abstract
The US Health and Human Services Pain Management Best Practices Inter-Agency Task Force initiated a public-private partnership which led to the publication of its report in 2019. The report emphasized the need for individualized, multimodal, and multidisciplinary approaches to pain management that decrease the over-reliance on opioids, increase access to care, and promote widespread education on pain and substance use disorders. The Task Force specifically called on specialty organizations to work together to develop evidence-based guidelines. In response to this report's recommendations, a consortium of 14 professional healthcare societies committed to a 2-year project to advance pain management for the surgical patient and improve opioid safety. The modified Delphi process included two rounds of electronic voting and culminated in a live virtual event in February 2021, during which seven common guiding principles were established for acute perioperative pain management. These principles should help to inform local action and future development of clinical practice recommendations.
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Affiliation(s)
- Edward R Mariano
- Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA .,Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - David M Dickerson
- Department of Anesthesiology, Critical Care and Pain Medicine, NorthShore University HealthSystem, Evanston, Illinois, USA.,Department of Anesthesia & Critical Care, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Joseph W Szokol
- Department of Anesthesiology, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Michael Harned
- Department of Anesthesiology, Division of Pain Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Jeffrey T Mueller
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Beverly K Philip
- American Society of Anesthesiologists, Schaumburg, Illinois, USA.,Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jaime L Baratta
- Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Padma Gulur
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jennifer Robles
- Department of Urology, Division of Endourology and Stone Disease, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Surgical Service, Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee, USA
| | - Kristopher M Schroeder
- Department of Anesthesiology, University of Wisconsin School of Medicine, Madison, Wisconsin, USA
| | - Karla E K Wyatt
- Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Houston, Texas, USA.,Department of Anesthesiology, Baylor College of Medicine, Houston, Texas, USA
| | - Jason M Schwalb
- Department of Neurological Surgery, Henry Ford Medical Group, Detroit, Michigan, USA
| | - Eric S Schwenk
- Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Richa Wardhan
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Todd S Kim
- Department of Orthopedic Surgery, Palo Alto Medical Foundation, Burlingame, California, USA
| | - Kent K Higdon
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Deepak G Krishnan
- Department of Oral & Maxillofacial Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio, USA.,Department of Oral & Maxillofacial Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Ashley M Shilling
- Department of Anesthesiology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Gary Schwartz
- AABP Integrative Pain Care, Brooklyn, New York, USA.,Department of Anesthesiology, Maimonides Medical Center, Brooklyn, New York, USA
| | - Lisa Wiechmann
- Department of Surgery, NewYork-Presbyterian/Columbia University Medical Center, New York, New York, USA
| | - Lisa V Doan
- Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Nabil M Elkassabany
- Department of Anesthesiology and Critical Care, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Stephen C Yang
- Department of Surgery, Division of Thoracic Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Iyabo O Muse
- Department of Anesthesiology, Westchester Medical Center/New York Medical College, Valhalla, New York, USA
| | - Jean D Eloy
- Department of Anesthesiology, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Vikas Mehta
- Department of Otolaryngology-Head and Neck Surgery, Montefiore Medical Center, Bronx, New York, USA
| | - Shalini Shah
- Department of Anesthesiology & Perioperative Care, University of California Irvine School of Medicine, Orange, California, USA
| | - Rebecca L Johnson
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Amanda Kallen
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut, USA
| | | | - Ashley Walton
- American Society of Anesthesiologists, Washington, District of Columbia, USA
| | - Asokumar Buvanendran
- Department of Anesthesiology, Rush University Medical Center, Chicago, Illinois, USA
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Santos-Parker JR, Santos-Parker KS, Caceres J, Vargas GM, Kwakye G, Englesbe MJ, Valbuena VSM. Building an Equitable Surgical Training Pipeline: Leadership Exposure for the Advancement of Gender and Underrepresented Minority Equity in Surgery (LEAGUES). J Surg Educ 2021; 78:1413-1418. [PMID: 33664009 DOI: 10.1016/j.jsurg.2021.01.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/12/2021] [Accepted: 01/23/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Underrepresented minority (URM) medical students face many educational challenges. Barriers include lack of equitable representation, scarce mentorship, and the effects of systemic racism. For students interested in diversity and health equity, perceptions of surgical culture may discourage pursuing surgical specialties. We describe a national pilot for a novel surgical pipeline program, Leadership Exposure for the Advancement of Gender and Underrepresented Minority Equity in Surgery (LEAGUES), which utilizes early exposure, mentorship, and community building to empower URM students in pursuit of academic surgical careers. DESIGN A 4-week virtual program included pairing students with faculty research mentors, virtual skills sessions, and seminars on leadership, advocacy, and career development. Participants underwent semi-structured interviews before and after participation, assessing experiences with mentorship and research, interest in surgery, career aspirations, and perceived barriers to career goals. SETTING Department of Surgery, Michigan Medicine, Ann Arbor, Michigan. PARTICIPANTS Rising second-year medical students. RESULTS All 3 participants were Latinx; 2 were first-generation college students. Participants had no surgical mentorship and limited research exposure, citing a desire to learn research methodology, connect with mentors, and build towards a career working with underserved communities as motivating factors for participation. Perceived barriers to a surgical career included surgical culture, burnout, and lack of research expertise or academic network necessary for success. At completion of the program, participants described several themes: (1) new positive perspective on academic surgical culture, (2) interest and confidence in research, (3) hope for improving health disparities, (4) networking and longitudinal mentorship connections contributing to a sense of surgical community, and (5) eagerness to share resources with colleagues at their home institutions. CONCLUSIONS LEAGUES program participants acquired tools and motivation to pursue careers in surgery, and established valuable longitudinal network and mentor relationships. LEAGUES is a novel model for national surgical pipeline programs.
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Affiliation(s)
| | | | - Juan Caceres
- University of Michigan Medical School, Ann Arbor, Michigan
| | | | - Gifty Kwakye
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | | | - Valeria S M Valbuena
- Department of Surgery, University of Michigan, Ann Arbor, Michigan; National Clinician Scholars Program, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan.
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35
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Stangl-Kremser J, Ahmadi H, Derstine B, Wang SC, Englesbe MJ, Daignault-Newton S, Chernin AS, Montgomery JS, Palapattu GS, Lee CT. Psoas Muscle Mass can Predict Postsurgical Outcomes in Patients Who Undergo Radical Cystectomy and Urinary Diversion Reconstruction. Urology 2021; 158:142-149. [PMID: 34437899 DOI: 10.1016/j.urology.2021.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To morphometrically measure to muscle mass which may reflect physical components of frailty. Hence, we evaluated the association between L4 total psoas area (TPA) and operative outcome after radical cystectomy (RC) for bladder cancer. METHODS In a retrospective single-center study, bladder cancer patients who underwent RC and urinary diversion between 2007 and 2012 were enrolled. TPA was evaluated in the cross-sectional imaging. The psoas muscles were normalized with the height. Male patients with a psoas mass index ≤7.4 cm2/m2 and female patients with a psoas mass index ≤5.2 cm2/m2 were classified as sarcopenic. Outcome measures were 30- and 90-day readmission and complications, and survival. Multivariable logistic and Cox proportional-hazards regression models were used to determine relevant predictors. RESULTS The median age of the 441 participants and follow up time was 68 years (IQR 59-75) and 1.2 years (IQR 0.5-1.9), respectively. One hundred forty-three patients (32.4%) were sarcopenic. The 30-day readmission and the complication rates were 13.8% and 44.7%, respectively. The 90-day readmission and complication rates were 23.9% and 53.1%, respectively. The 1-year mortality rate was 11.6% (95%CI 8.7-15.4). Multivariable logistic regression analysis revealed an association between increased TPA and lower odds of 30-day complications after RC (OR 0.95, 95%CI 0.92-0.99, P = .02); similarly, an increase in TPA was of prognostic value, although not statistically significant in the multivariable model (P = .05) once adjusting for other patient factors. CONCLUSION Sarcopenia predicted early complications and showed an informative trend for overall survival after RC, and thus may inform models predicting postsurgical outcomes.
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Affiliation(s)
- Judith Stangl-Kremser
- Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, Michigan Medicine, Ann Arbor, MI
| | - Hamed Ahmadi
- Department of Urology, University of Southern California, Los Angeles, CA
| | | | | | | | - Stephanie Daignault-Newton
- Department of Urology, Michigan Medicine, Ann Arbor, MI; Department of Biostatistics, Michigan Medicine, Ann Arbor, MI
| | - Anna S Chernin
- Department of Biostatistics, Michigan Medicine, Ann Arbor, MI
| | | | - Ganesh S Palapattu
- Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, Michigan Medicine, Ann Arbor, MI
| | - Cheryl T Lee
- Department of Urology, Michigan Medicine, Ann Arbor, MI; Department of Urology, The Ohio State University, Columbus, OH.
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36
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Brown CS, Waits SA, Englesbe MJ, Sonnenday CJ, Sheetz KH. Associations Among Different Domains of Quality Among US Liver Transplant Programs. JAMA Netw Open 2021; 4:e2118502. [PMID: 34369991 PMCID: PMC8353538 DOI: 10.1001/jamanetworkopen.2021.18502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/21/2021] [Indexed: 12/20/2022] Open
Abstract
Importance US liver transplant programs have traditionally been evaluated on 1-year patient and graft survival. However, there is concern that a narrow focus on recipient outcomes may not incentivize programs to improve in other ways that would benefit patients with end-stage liver disease. Objective To determine the correlation among different potential domains of quality for adult liver transplant programs. Design, Setting, and Participants This retrospective cohort study was conducted from 2014 to 2019 among adult liver transplant programs included in the United Network for Organ Sharing and Scientific Registry of Transplant Recipients program-specific reports. Liver transplant programs in the United States completing at least 10 liver transplants per year were included. Data were analyzed from March 2 to August 13, 2020. Main Outcomes and Measures The potential domains of quality examined included recipient outcomes (1-year graft and patient survival), aggressiveness (ie, marginal graft use, defined as the rate of use of donors with body mass index [calculated as weight in kilograms divided by height in meters squared] greater than 40, age older than 65 years, or deceased by cardiac death), and waiting list management (ie, waiting list mortality). The correlation among measures, aggregated at the center level, was evaluated using linear regression to control for mean Model for End Stage Liver Disease-Sodium score at organ allocation. The extent to which programs were able to achieve high quality across multiple domains was also evaluated. Results Among 114 transplant programs that performed a total of 44 554 transplants, the mean (SD) 1-year graft and patient survival was 90.3% (3.0%) with a total range of 75.9% to 96.6%. The mean (SD) waiting list mortality rate was 16.7 (6.1) deaths per 100 person-years, with a total range of 6.3 to 53.0 deaths per 100 person years. The mean (SD) marginal graft use rate was 15.8 (8.8) donors per 100 transplants, with a total range of 0 to 49.3 donors. There was no correlation between 1-year graft and patient survival and waiting list mortality (β = -0.053; P = .19) or marginal graft use (β = -0.007; P = .84) after correcting for mean allocation Model for End Stage Liver Disease-Sodium scores. There were 2 transplant programs (1.8%) that performed in the top quartile on all 3 measures, while 4 transplant programs (3.6%) performed in the bottom quartile on all 3 measures. Conclusions and Relevance This cohort study found that among US liver transplant programs, there were no correlations among 1-year recipient outcomes, measures of program aggressiveness, or waiting list management. These findings suggest that a program's performance in one domain may be independent and unrelated to its performance on others and that the understanding of factors contributing to these domains is incomplete.
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Affiliation(s)
- Craig S. Brown
- Department of Surgery, University of Michigan, Ann Arbor
| | - Seth A. Waits
- Department of Surgery, University of Michigan, Ann Arbor
| | | | | | - Kyle H. Sheetz
- Department of Surgery, University of Michigan, Ann Arbor
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Baker RC, Brown CS, Montgomery JR, Mouch CA, Kenney BC, Englesbe MJ, Waljee JF, Hemmila MR. Effect of injury location and severity on opioid use after trauma. J Trauma Acute Care Surg 2021; 91:226-233. [PMID: 34144565 PMCID: PMC8243856 DOI: 10.1097/ta.0000000000003138] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Recent data have suggested that persistent opioid use is prevalent following trauma. The effect of type of injury and total injury burden is not known. We sought to characterize the relationship between injury location and severity and risk of persistent opioid use. METHODS We investigated postdischarge opioid utilization among patients who were admitted for trauma between January 2010 and June 2017 using the Optum Clinformatics Database. New persistent opioid use (NPOU) was defined as one of the following scenarios: (1) two separate opioid prescription fills between 0 and 14 days postdischarge and having 1+ fills in the 91 to 180 days following discharge or (2) filling a prescription in the 15 to 90 days following discharge in addition to a filling in the 91 to 180 day postdischarge period. Multivariable logistic regression was used to assess the relationship between injury type and severity with new persistent opioid use development. RESULTS A total of 26,437 opioid-naive patients were included in the analysis. Overall, 2,277 patients (8.6%) met the criteria for NPOU. After adjustment for confounding, NPOU was significantly more common for patients with injury to the extremities (adjusted odds ratio [aOR], 1.75; 95% confidence interval [CI], 1.57-1.94) or abdomen (adjusted odds ratio [aOR], 1.42; 95% CI, 1.22-1.64). Importantly, patients with maximum Abbreviated Injury Scale score of ≥2 for any body region had 1.49-fold odds of NPOU compared with patients with score of 1 (95% CI, 1.28-1.73), while no difference was seen across groupings of total injury burden based on Injury Severity Score. CONCLUSION New persistent opioid use is common among patients suffering from trauma. In addition, patients suffering from extremity and abdominal injuries are at highest risk. Maximum individual region injury severity predicts development of new persistent use, whereas total injury severity does not. LEVEL OF EVIDENCE Prognostic and epidemiological, level III.
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Affiliation(s)
- Rachel C. Baker
- Department of Surgery, University of Michigan, Ann Arbor, MI 48109
- Michigan Opioid Prescribing Engagement Network, Ann Arbor, MI 48109
| | - Craig S. Brown
- Department of Surgery, University of Michigan, Ann Arbor, MI 48109
- Michigan Opioid Prescribing Engagement Network, Ann Arbor, MI 48109
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI 48109
| | - John R. Montgomery
- Department of Surgery, University of Michigan, Ann Arbor, MI 48109
- Michigan Opioid Prescribing Engagement Network, Ann Arbor, MI 48109
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI 48109
| | - Charles A. Mouch
- Department of Surgery, University of Michigan, Ann Arbor, MI 48109
- Michigan Opioid Prescribing Engagement Network, Ann Arbor, MI 48109
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI 48109
| | - Brooke C. Kenney
- Michigan Opioid Prescribing Engagement Network, Ann Arbor, MI 48109
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI 48109
| | - Michael J. Englesbe
- Department of Surgery, University of Michigan, Ann Arbor, MI 48109
- Michigan Opioid Prescribing Engagement Network, Ann Arbor, MI 48109
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI 48109
| | - Jennifer F. Waljee
- Department of Surgery, University of Michigan, Ann Arbor, MI 48109
- Michigan Opioid Prescribing Engagement Network, Ann Arbor, MI 48109
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI 48109
| | - Mark R. Hemmila
- Department of Surgery, University of Michigan, Ann Arbor, MI 48109
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI 48109
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Brown CS, Osborne NH, Hu HM, Coleman D, Englesbe MJ, Waljee JF, Brummett CM, Vemuri C. Endovascular surgery is not protective against new persistent opioid use development compared to open vascular surgery. Vascular 2021; 30:728-738. [PMID: 34128428 DOI: 10.1177/17085381211024514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Endovascular techniques continue to be increasingly utilized to treat vascular disease, but the effect of these minimally invasive techniques on opioid use following surgery is not known. METHODS Using Medicare data, we identified opioid-naive patients undergoing vascular procedures between 2009 and 2017. We selected patients ≥65 years old with continuous enrollment 12 months before and 6 months after surgery and had no additional operations. We defined new persistent opioid use (NPOU) as one or more opioid prescription fills both between 4-90 and 91-180 days postoperatively. Multivariable regression was performed for risk adjustment, and frequencies of NPOU were estimated between endovascular and open techniques to compare surgical approach. RESULTS A total of 77,767 patients were identified, with 2.6% of all patients developing new persistent use. In addition to the identification of several risk factors for new persistent use, patients undergoing endovascular carotid or vertebral interventions were found to have higher adjusted frequencies of persistent use compared to those undergoing open interventions (3.0% vs. 1.8%, p < 0.001) as did those undergoing endovenous compared to open vein procedures (2.2%, vs. 1.6%, p = 0.019). We found no difference for peripheral vascular or aortic/iliac procedures. CONCLUSIONS Patients undergoing vascular surgery are at high risk for new persistent use. Undergoing endovascular carotid or venous surgery was associated with an increased risk of NPOU, whereas no differences were found between endovascular and open approaches for peripheral arterial or aortic disease.
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Affiliation(s)
- Craig S Brown
- Section of Vascular Surgery, Department of Surgery, 1259University of Michigan, Ann Arbor, MI, USA.,Michigan Opioid Prescribing and Engagement Network, Ann Arbor, MI, USA
| | - Nicholas H Osborne
- Section of Vascular Surgery, Department of Surgery, 1259University of Michigan, Ann Arbor, MI, USA
| | - Hsou M Hu
- Michigan Opioid Prescribing and Engagement Network, Ann Arbor, MI, USA
| | - Dawn Coleman
- Section of Vascular Surgery, Department of Surgery, 1259University of Michigan, Ann Arbor, MI, USA
| | - Michael J Englesbe
- Michigan Opioid Prescribing and Engagement Network, Ann Arbor, MI, USA.,Section of Transplantation, Department of Surgery, 1259University of Michigan, Ann Arbor, MI, USA
| | - Jennifer F Waljee
- Michigan Opioid Prescribing and Engagement Network, Ann Arbor, MI, USA.,Section of Plastic Surgery, Department of Surgery, 1259University of Michigan, Ann Arbor, MI, USA
| | - Chad M Brummett
- Michigan Opioid Prescribing and Engagement Network, Ann Arbor, MI, USA.,Department of Anesthesia, 1259University of Michigan, Ann Arbor, MI, USA
| | - Chandu Vemuri
- Section of Vascular Surgery, Department of Surgery, 1259University of Michigan, Ann Arbor, MI, USA
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39
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Eton RE, Schaefer SL, Englesbe MJ. Regional Variation in Pediatric Deceased Organ Donation Consent Rates Is Costing Lives. Pediatrics 2021; 147:peds.2021-050048. [PMID: 33963075 DOI: 10.1542/peds.2021-050048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/25/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Ryan E Eton
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
| | - Sara L Schaefer
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
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40
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Eton RE, Highet A, Englesbe MJ. Every Emergency General Surgery Patient Deserves Pathway-Driven Care. J Am Coll Surg 2021; 231:764-765. [PMID: 33243402 DOI: 10.1016/j.jamcollsurg.2020.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 09/08/2020] [Indexed: 12/29/2022]
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41
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Englesbe MJ, Pearson TC. Family vouchers-Unique innovation in need of continuous quality assurance. Am J Transplant 2021; 21:923-924. [PMID: 32738162 DOI: 10.1111/ajt.16228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/05/2020] [Accepted: 07/06/2020] [Indexed: 01/25/2023]
Affiliation(s)
- Michael J Englesbe
- Department of Surgery, Section of Transplantation, University of Michigan, Ann Arbor, Michigan, USA
| | - Thomas C Pearson
- Department of Surgery, Division of Transplantation, Emory University, Atlanta, Georgia, USA
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42
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Jafri SM, Vitous CA, Dossett LA, Seven C, Englesbe MJ, Sales A, Telem DA. Surgeon Attitudes and Beliefs Toward Abdominal Wall Hernia Repair in Female Patients of Childbearing Age. JAMA Surg 2021; 155:528-530. [PMID: 32211840 DOI: 10.1001/jamasurg.2020.0099] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Sara M Jafri
- University of Michigan, Center for Healthcare Outcomes and Policy, Ann Arbor
| | - C Ann Vitous
- University of Michigan, Center for Healthcare Outcomes and Policy, Ann Arbor
| | | | - Claire Seven
- University of Michigan, Center for Healthcare Outcomes and Policy, Ann Arbor
| | | | - Anne Sales
- University of Michigan, Department of Learning Health Sciences, School of Medicine, Ann Arbor
| | - Dana A Telem
- University of Michigan, Department of Surgery, Ann Arbor
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43
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Santos-Parker JR, Cassidy DE, Gomez-Rexrode AE, Englesbe MJ, Valbuena VSM. Meeting Patients at the Dialysis Chair: The Expanding Role of Telemedicine to Address Disparities in Access to Kidney Transplantation. Am J Kidney Dis 2021; 78:5-8. [PMID: 33508398 DOI: 10.1053/j.ajkd.2020.12.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 12/31/2020] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | - Michael J Englesbe
- Department of Surgery, Section of Transplantation, University of Michigan, Ann Arbor, MI.
| | - Valeria S M Valbuena
- Department of Surgery, Section of Transplantation, University of Michigan, Ann Arbor, MI; Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI; National Clinician Scholars Program, University of Michigan, Ann Arbor, MI
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44
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Brown CS, Eton RE, Corriere MA, Henke PK, Englesbe MJ, Osborne NH. Using Payment Incentives to Decrease Atherectomy Overutilization. Ann Vasc Surg 2021; 73:144-146. [PMID: 33485907 DOI: 10.1016/j.avsg.2021.01.061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 01/10/2021] [Accepted: 01/14/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Craig S Brown
- Department of Surgery, University of Michigan, Ann Arbor, MI; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI.
| | - Ryan E Eton
- Department of Surgery, University of Michigan, Ann Arbor, MI; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
| | - Matthew A Corriere
- Department of Surgery, University of Michigan, Ann Arbor, MI; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
| | - Peter K Henke
- Department of Surgery, University of Michigan, Ann Arbor, MI; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
| | - Michael J Englesbe
- Department of Surgery, University of Michigan, Ann Arbor, MI; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
| | - Nicholas H Osborne
- Department of Surgery, University of Michigan, Ann Arbor, MI; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
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45
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Cron DC, Tincopa MA, Lee JS, Waljee AK, Hammoud A, Brummett CM, Waljee JF, Englesbe MJ, Sonnenday CJ. Prevalence and Patterns of Opioid Use Before and After Liver Transplantation. Transplantation 2021; 105:100-107. [PMID: 32022738 PMCID: PMC7398834 DOI: 10.1097/tp.0000000000003155] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Opioid use in liver transplantation is poorly understood and has potential associated morbidity. METHODS Using a national data set of employer-based insurance claims, we identified 1257 adults who underwent liver transplantation between December 2009 and February 2015. We categorized patients based on their duration of opioid fills over the year before and after transplant admission as opioid-naive/no fills, chronic opioid use (≥120 d supply), and intermittent use (all other use). We calculated risk-adjusted prevalence of peritransplant opioid fills, assessed changes in opioid use after transplant, and identified correlates of persistent or increased opioid use posttransplant. RESULTS Overall, 45% of patients filled ≥1 opioid prescription in the year before transplant (35% intermittent use, 10% chronic). Posttransplant, 61% of patients filled an opioid prescription 0-2 months after discharge, and 21% filled an opioid between 10-12 months after discharge. Among previously opioid-naive patients, 4% developed chronic use posttransplant. Among patients with pretransplant opioid use, 84% remained intermittent or increased to chronic use, and 73% of chronic users remained chronic users after transplant. Pretransplant opioid use (risk factor) and hepatobiliary malignancy (protective) were the only factors independently associated with risk of persistent or increased posttransplant opioid use. CONCLUSIONS Prescription opioid use is common before and after liver transplant, with intermittent and chronic use largely persisting, and a small development of new chronic use posttransplant. To minimize the morbidity of long-term opioid use, it is critical to improve pain management and optimize opioid use before and after liver transplant.
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Affiliation(s)
- David C Cron
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Monica A Tincopa
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Jay S Lee
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - Akbar K Waljee
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
- Veteran's Affairs Center for Clinical Management Research, Ann Arbor, MI
| | - Ali Hammoud
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - Chad M Brummett
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
- Division of Pain Research, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI
| | - Jennifer F Waljee
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - Michael J Englesbe
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - Christopher J Sonnenday
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
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46
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Eyrich NW, Sloss KR, Howard RA, Klueh MP, Englesbe MJ, Waljee JF, Brummett CM, Sabel MS, Dossett LA, Lee JS. Opioid prescribing exceeds consumption following common surgical oncology procedures. J Surg Oncol 2021; 123:352-356. [PMID: 33125747 PMCID: PMC7770117 DOI: 10.1002/jso.26272] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 09/24/2020] [Accepted: 10/11/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND OBJECTIVES Surgical oncology patients are vulnerable to persistent opioid use. As such, we aim to compare opioid prescribing to opioid consumption for common surgical oncology procedures. METHODS We prospectively identified patients undergoing common surgical oncology procedures at a single academic institution (August 2017-March 2018). Patients were contacted by telephone within 6 months of surgery and asked to report their opioid consumption and describe their discharge instructions and opioid handling practices. RESULTS Of the 439 patients who were approached via telephone, 270 completed at least one survey portion. The median quantity of opioid prescribed was significantly larger than consumed following breast biopsy (5 vs. 2 tablets of 5 mg oxycodone, p < .001), lumpectomy (10 vs. 2 tablets of 5 mg oxycodone, p < .001), and mastectomy or wide local excision (20 tablets vs. 2 tablets of 5 mg oxycodone, p < .001). The majority of patients reported receiving education on taking opioids, but only 27% received instructions on proper disposal; 82% of prescriptions filled resulted in unused opioids, and only 11% of these patients safely disposed of them. CONCLUSIONS This study demonstrates that opioid prescribing exceeds consumption following common surgical oncology procedures, indicating the potential for reductions in prescribing.
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Affiliation(s)
| | | | - Ryan A. Howard
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Michael P. Klueh
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI
| | - Michael J. Englesbe
- Department of Surgery, University of Michigan, Ann Arbor, MI
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
| | - Jennifer F. Waljee
- Department of Surgery, University of Michigan, Ann Arbor, MI
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
| | - Chad M. Brummett
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI
| | - Michael S. Sabel
- Department of Surgery, University of Michigan, Ann Arbor, MI
- Division of Surgical Oncology, University of Michigan, Ann Arbor, MI
| | - Lesly A. Dossett
- Department of Surgery, University of Michigan, Ann Arbor, MI
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
- Division of Surgical Oncology, University of Michigan, Ann Arbor, MI
| | - Jay S. Lee
- Department of Surgery, University of Michigan, Ann Arbor, MI
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
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47
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Highet A, Gomez-Rexrode AE, Barrett M, Santos-Parker KS, Santos-Parker JR, Cassidy DE, Herman AE, Kulick AA, Brown CS, Montgomery JR, Wakam GK, Englesbe MJ, Waits SA. Fostering Passion and Skills in Surgical Research Across the Medical Education Continuum: The Transplant Research, Education, and Engagement Group. J Surg Educ 2021; 78:356-360. [PMID: 32739442 PMCID: PMC7788517 DOI: 10.1016/j.jsurg.2020.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 07/11/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE We describe a multilevel, collaborative research group for trainees and faculty engaging in transplant surgery research within one institution. DESIGN Transplant Research, Education, and Engagement (TREE) was designed to develop trainees' research skills and foster enthusiasm in transplant surgery along the educational continuum. Our research model intentionally empowers junior researchers, including undergraduates and medical students, to assume active roles on a range of research projects and contribute new ideas within a welcoming research and learning environment. SETTING Section of Transplant Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, Michigan. PARTICIPANTS Undergraduate premedical students, first through fourth year medical students, general surgery residents, transplant surgery fellows, and transplant surgery faculty. RESULTS TREE was founded in September 2019 and has grown to include over 30 active members who meet weekly and collaborate virtually on a range of research projects, many of which are led by students. Trainees can assume both mentee and mentor roles and build their research, presentation and writing skills while collaborating academically. CONCLUSIONS Our model has increased trainees' engagement in transplant research projects and fosters early enthusiasm for the field. This model can be feasibly replicated at other institutions and within other subspecialties.
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Affiliation(s)
- Alexandra Highet
- Transplant Research, Education and Engagement, Section of Transplant Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, Michigan; University of Michigan Medical School, Ann Arbor, Michigan
| | - Amalia E Gomez-Rexrode
- Transplant Research, Education and Engagement, Section of Transplant Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, Michigan; University of Michigan Medical School, Ann Arbor, Michigan
| | - Meredith Barrett
- Transplant Research, Education and Engagement, Section of Transplant Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
| | - Keli S Santos-Parker
- Transplant Research, Education and Engagement, Section of Transplant Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, Michigan; University of Michigan Medical School, Ann Arbor, Michigan
| | - Jessica R Santos-Parker
- Transplant Research, Education and Engagement, Section of Transplant Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, Michigan; University of Michigan Medical School, Ann Arbor, Michigan
| | - Devon E Cassidy
- Transplant Research, Education and Engagement, Section of Transplant Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, Michigan; University of Michigan Medical School, Ann Arbor, Michigan
| | - Alexandra E Herman
- Transplant Research, Education and Engagement, Section of Transplant Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, Michigan; University of Michigan Medical School, Ann Arbor, Michigan
| | - Alexandra A Kulick
- Transplant Research, Education and Engagement, Section of Transplant Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, Michigan; University of Michigan Medical School, Ann Arbor, Michigan
| | - Craig S Brown
- University of Michigan Medical School, Ann Arbor, Michigan; Center for Health Outcomes and Policy, Michigan Medicine, Ann Arbor, Michigan
| | - John R Montgomery
- University of Michigan Medical School, Ann Arbor, Michigan; Center for Health Outcomes and Policy, Michigan Medicine, Ann Arbor, Michigan
| | - Glenn K Wakam
- Transplant Research, Education and Engagement, Section of Transplant Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
| | - Michael J Englesbe
- Transplant Research, Education and Engagement, Section of Transplant Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, Michigan; University of Michigan Medical School, Ann Arbor, Michigan; Center for Health Outcomes and Policy, Michigan Medicine, Ann Arbor, Michigan
| | - Seth A Waits
- University of Michigan Medical School, Ann Arbor, Michigan.
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48
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Kassam AF, Cortez AR, Winer LK, Conzen KD, El-Hinnawi A, Jones CM, Matsuoka L, Watkins AC, Collins KM, Bhati C, Selzner M, Sonnenday CJ, Englesbe MJ, Diwan TS, Dick AAS, Quillin RC. Extinguishing burnout: National analysis of predictors and effects of burnout in abdominal transplant surgery fellows. Am J Transplant 2021; 21:307-313. [PMID: 32463950 DOI: 10.1111/ajt.16075] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/13/2020] [Accepted: 05/15/2020] [Indexed: 01/25/2023]
Abstract
Burnout among surgeons has been attributed to increased workload and decreased autonomy. Although prior studies have examined burnout among transplant surgeons, no studies have evaluated burnout in abdominal transplant surgery fellows. The objective of our study was to identify predictors of burnout and understand its impact on personal and patient care during fellowship. A survey was sent to all abdominal transplant surgery fellows in an American Society of Transplant Surgeons-accredited fellowship. The response rate was 59.2% (n = 77) and 22.7% (n = 17) of fellows met criteria for burnout. Fellows with lower grit scores were more likely to exhibit burnout compared with fellows with higher scores (3.6 vs 4.0, P = .026). Those with burnout were more likely to work >100 hours per week (58.8% vs 27.6%, P = .023), have severe work-related stress (58.8% vs 22.4%, P = .010), consider quitting fellowship (94.1% vs 20.7%, P < .001), or make a medical error (35.3% vs 5.2%, P = .003). This national analysis of abdominal transplant fellows found that burnout rates are relatively low, but few fellows engage in self-care. Personal and program-related factors attribute to burnout and it has unacceptable effects on patient care. Transplant societies and fellowship programs should develop interventions to give fellows tools to prevent and combat burnout.
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Affiliation(s)
- Al-Faraaz Kassam
- Cincinnati Research on Education in Surgical Training (CREST), Cincinnati, Ohio, USA.,Department of Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Alexander R Cortez
- Cincinnati Research on Education in Surgical Training (CREST), Cincinnati, Ohio, USA.,Department of Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Leah K Winer
- Cincinnati Research on Education in Surgical Training (CREST), Cincinnati, Ohio, USA.,Department of Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Kendra D Conzen
- Department of Surgery, University of Colorado, Aurora, Colorado, USA
| | - Ashraf El-Hinnawi
- Department of Surgery, The Ohio State University, Columbus, Ohio, USA
| | | | - Lea Matsuoka
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Anthony C Watkins
- Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York, USA
| | - Kelly M Collins
- Department of Transplantation and Hepatobiliary Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Chandra Bhati
- Department of Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Markus Selzner
- Department of Surgery, Toronto General Hospital, Toronto, Ontario, Canada
| | | | | | - Tayyab S Diwan
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - André A S Dick
- Department of Surgery, University of Washington, Seattle, Washington, USA.,Seattle Children's Hospital, Seattle, Washington, USA
| | - Ralph C Quillin
- Cincinnati Research on Education in Surgical Training (CREST), Cincinnati, Ohio, USA.,Department of Surgery, University of Cincinnati, Cincinnati, Ohio, USA
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49
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Santosa KB, Lai YL, Oliver JD, Hu HM, Brummett CM, Englesbe MJ, Waljee JF. Preoperative Opioid Use and Mortality After Minor Outpatient Surgery. JAMA Surg 2020; 155:1169-1171. [PMID: 33084877 DOI: 10.1001/jamasurg.2020.3623] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Katherine B Santosa
- Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor
| | - Yen-Ling Lai
- Michigan Opioid Prescribing Engagement Network, Ann Arbor
| | - Jeremie D Oliver
- Department of Biomedical Engineering, University of Utah, Bountiful
| | - Hsou-Mei Hu
- Michigan Opioid Prescribing Engagement Network, Ann Arbor
| | - Chad M Brummett
- Division of Pain Medicine, Department of Anesthesia, University of Michigan Health System, Ann Arbor
| | - Michael J Englesbe
- Section of Transplantation, Department of Surgery, University of Michigan Health System, Ann Arbor
| | - Jennifer F Waljee
- Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor
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50
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Kaye DR, Schafer C, Thelen-Perry S, Parker C, Iglay-Reger H, Daignault-Newton S, Qin Y, Morgan TM, Weizer AZ, Kaffenberger SD, Herrel LA, Hafez KS, Lee CT, Skolarus TA, Englesbe MJ, Montgomery JS. The Feasibility and Impact of a Presurgical Exercise Intervention Program (Prehabilitation) for Patients Undergoing Cystectomy for Bladder Cancer. Urology 2020; 145:106-112. [DOI: 10.1016/j.urology.2020.05.104] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 04/21/2020] [Accepted: 05/17/2020] [Indexed: 01/22/2023]
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