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Dunn LK, Taylor DG, Chen CJ, Singla P, Fernández L, Wiedle CH, Hanak MF, Tsang S, Smith JS, Shaffrey CI, Nemergut EC, Durieux ME, Blank RS, Naik BI. Ventilator Mode Does Not Influence Blood Loss or Transfusion Requirements During Major Spine Surgery. Anesth Analg 2020; 130:100-110. [DOI: 10.1213/ane.0000000000004322] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Dunn LK, Taylor DG, Smith SJ, Skojec AJ, Wang TR, Chung J, Hanak MF, Lacomis CD, Palmer JD, Ruminski C, Fang S, Tsang S, Spangler SN, Durieux ME, Naik BI. Persistent post-discharge opioid prescribing after traumatic brain injury requiring intensive care unit admission: A cross-sectional study with longitudinal outcome. PLoS One 2019; 14:e0225787. [PMID: 31774864 PMCID: PMC6880998 DOI: 10.1371/journal.pone.0225787] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 11/12/2019] [Indexed: 12/16/2022] Open
Abstract
Traumatic brain injury (TBI) is associated with increased risk for psychological and substance use disorders. The study aim is to determine incidence and risk factors for persistent opioid prescription after hospitalization for TBI. Electronic medical records of patients age ≥ 18 admitted to a neuroscience intensive care unit between January 2013 and February 2017 for an intracranial injury were retrospectively reviewed. Primary outcome was opioid use through 12 months post-hospital discharge. A total of 298 patients with complete data were included in the analysis. The prevalence of opioid use among preadmission opioid users was 48 (87%), 36 (69%) and 22 (56%) at 1, 6 and 12-months post-discharge, respectively. In the opioid naïve group, 69 (41%), 24 (23%) and 17 (19%) were prescribed opioids at 1, 6 and 12 months, respectively. Preadmission opioid use (OR 324.8, 95% CI 23.1-16907.5, p = 0.0004) and higher opioid requirements during hospitalization (OR 4.5, 95% CI 1.8-16.3, p = 0.006) were independently associated with an increased risk of being prescribed opioids 12 months post-discharge. These factors may be used to identify and target at-risk patients for intervention.
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Affiliation(s)
- Lauren K. Dunn
- Department of Anesthesiology, University of Virginia Health System, Charlottesville, Virginia, United States of America
- * E-mail:
| | - Davis G. Taylor
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, United States of America
| | - Samantha J Smith
- Department of Anesthesiology, University of Virginia Health System, Charlottesville, Virginia, United States of America
| | - Alexander J. Skojec
- Department of Anesthesiology, University of Virginia Health System, Charlottesville, Virginia, United States of America
| | - Tony R. Wang
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, United States of America
| | - Joyce Chung
- Department of Anesthesiology, University of Virginia Health System, Charlottesville, Virginia, United States of America
| | - Mark F. Hanak
- Department of Anesthesiology, University of Virginia Health System, Charlottesville, Virginia, United States of America
| | - Christopher D. Lacomis
- Department of Anesthesiology, University of Virginia Health System, Charlottesville, Virginia, United States of America
| | - Justin D. Palmer
- Department of Anesthesiology, University of Virginia Health System, Charlottesville, Virginia, United States of America
| | - Caroline Ruminski
- Department of Anesthesiology, University of Virginia Health System, Charlottesville, Virginia, United States of America
| | - Shenghao Fang
- Department of Anesthesiology, University of Virginia Health System, Charlottesville, Virginia, United States of America
| | - Siny Tsang
- Nutrition and Exercise Physiology, Washington State University, Spokane, Washington, United States of America
| | - Sarah N. Spangler
- Department of Anesthesiology, University of Virginia Health System, Charlottesville, Virginia, United States of America
| | - Marcel E. Durieux
- Department of Anesthesiology, University of Virginia Health System, Charlottesville, Virginia, United States of America
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, United States of America
| | - Bhiken I. Naik
- Department of Anesthesiology, University of Virginia Health System, Charlottesville, Virginia, United States of America
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, United States of America
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Dunn LK, Yerra S, Fang S, Hanak MF, Leibowitz MK, Tsang S, Durieux ME, Nemergut EC, Naik BI. Incidence and Risk Factors for Chronic Postoperative Opioid Use After Major Spine Surgery: A Cross-Sectional Study With Longitudinal Outcome. Anesth Analg 2019; 127:247-254. [PMID: 29570151 DOI: 10.1213/ane.0000000000003338] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Chronic opioid use is a significant public health concern. Surgery is a risk factor for developing chronic opioid use. Patients undergoing major spine surgery frequently are prescribed opioids preoperatively and may be at risk for chronic opioid use postoperatively. The aim of this study was to investigate the incidence of and perioperative risk factors associated with chronic opioid use after major spine surgery. METHODS The records of patients who underwent elective major spine surgery at the University of Virginia between March 2011 and February 2016 were retrospectively reviewed. The primary outcome was chronic opioid use through 12 months postoperatively. Demographic data, medical comorbidities, preoperative pain scores, and medication use including daily morphine-equivalent (ME) dose, intraoperative use of lidocaine and ketamine, estimated blood loss, postoperative pain scores and medication use, and postoperative opioid use were collected. Logistic regression models were used to examine factors associated with chronic opioid use. RESULTS Of 1477 patient records reviewed, 412 patients (27.9%) were opioid naive and 1065 patients (72.3%) used opioids before surgery. Opioid data were available for 1325 patients, while 152 patients were lost to 12-month follow-up and were excluded. Of 958 preoperative opioid users, 498 (52.0%) remained chronic users through 12 months. There was a decrease in opioid dosage (mg ME) from preoperative to 12 months postoperatively with a mean difference of -14.7 mg ME (standard deviation, 1.57; 95% confidence interval [CI], -17.8 to -11.7). Among 367 previously opioid-naive patients, 67 (18.3%) became chronic opioid users. Factors associated with chronic opioid use were examined using logistic regression models. Preoperative opioid users were nearly 4 times more likely to be chronic opioid users through 12 months than were opioid-naive patients (odds ratio, 3.95; 95% CI, 2.51-6.33; P < .001). Mean postoperative pain score (0-10) was associated with increased odds of chronic opioid use (odds ratio for a 1 unit increase in pain score 1.25, 95% CI, 1.13-1.38; P < .001). Use of intravenous ketamine or lidocaine was not associated with chronic opioid use through 12 months. CONCLUSIONS Greater than 70% of patients presenting for major spine surgery used opioids preoperatively. Preoperative opioid use and higher postoperative pain scores were associated with chronic opioid use through 12 months. Use of ketamine and lidocaine did not decrease the risk for chronic opioid use. Surveillance of patients for these factors may identify those at highest risk for chronic opioid use and target them for intervention and reduction strategies.
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Affiliation(s)
- Lauren K Dunn
- From the Department of Anesthesiology, University of Virginia, Charlottesville, Virginia
| | - Sandeep Yerra
- From the Department of Anesthesiology, University of Virginia, Charlottesville, Virginia
| | - Shenghao Fang
- From the Department of Anesthesiology, University of Virginia, Charlottesville, Virginia
| | - Mark F Hanak
- From the Department of Anesthesiology, University of Virginia, Charlottesville, Virginia
| | - Maren K Leibowitz
- From the Department of Anesthesiology, University of Virginia, Charlottesville, Virginia
| | - Siny Tsang
- Department of Epidemiology, Columbia University, New York, New York
| | - Marcel E Durieux
- From the Department of Anesthesiology, University of Virginia, Charlottesville, Virginia.,Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Edward C Nemergut
- From the Department of Anesthesiology, University of Virginia, Charlottesville, Virginia.,Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Bhiken I Naik
- From the Department of Anesthesiology, University of Virginia, Charlottesville, Virginia.,Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
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Dunn LK, Yerra S, Fang S, Hanak MF, Leibowitz MK, Alpert SB, Tsang S, Durieux ME, Nemergut EC, Naik BI. Safety profile of intraoperative methadone for analgesia after major spine surgery: An observational study of 1,478 patients. J Opioid Manag 2018; 14:83-87. [PMID: 29733094 DOI: 10.5055/jom.2018.0435] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To investigate the incidence of perioperative adverse events in patients receiving intravenous methadone for major spine surgery. DESIGN Retrospective review of perioperative records from March 2011 and February 2016. SETTING University of Virginia Healthsystem. PATIENTS Adult patients undergoing elective spinal fusion of two or more levels. MAIN OUTCOME MEASURES Incidence of respiratory depression, time to extubation, hypotension, hypoxemia, reintubation, cardiac complications, and death. RESULTS Reviewed 1,478 patient records. Mean intraoperative methadone dose was 0.14 ± 0.07 mg/kg. A total of 1,142 patients (77.4 percent) were extubated in the operating room, 543 (36.8 percent) experienced respiratory depression, 1,180 (79.8 percent) hypoxemia, and 22 (1.5 percent) required reintubation. Cardiac complications included arrhythmias (289 patients, 29.9 percent), QTc prolongation (568 patients, 58.8 percent), and myocardial infarction (16 patients, 1.1 percent). Two in hospital deaths occurred (0.14 percent). CONCLUSIONS Mild-moderate respiratory depression is observed following a one-time dose of intraoperative methadone, and monitoring in an appropriate postoperative setting is recommended.
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Affiliation(s)
- Lauren K Dunn
- Department of Anesthesiology, University of Virginia, Charlottesville, Virginia
| | - Sandeep Yerra
- Department of Anesthesiology, University of Virginia, Charlottesville, Virginia
| | - Shenghao Fang
- Department of Anesthesiology, University of Virginia, Charlottesville, Virginia
| | - Mark F Hanak
- Department of Anesthesiology, University of Virginia, Charlottesville, Virginia
| | - Maren K Leibowitz
- Department of Anesthesiology, University of Virginia, Charlottesville, Virginia
| | - Salome B Alpert
- Department of Anesthesiology, University of Virginia, Charlottesville, Virginia
| | - Siny Tsang
- Department of Epidemiology, Columbia University, New York, New York
| | - Marcel E Durieux
- Department of Anesthesiology, University of Virginia, Charlottesville, Virginia; Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Edward C Nemergut
- Department of Anesthesiology, University of Virginia, Charlottesville, Virginia; Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Bhiken I Naik
- Department of Anesthesiology, University of Virginia, Charlottesville, Virginia; Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
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