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  • BMJ  (6)
  • Fiasconaro, Megan  (6)
  • 1
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    Tranexamic acid administration during total joint arthroplasty surgery is not associated with an increased risk of perioperative seizures: a national database analysis
    BMJ ; 2020
    In:  Regional Anesthesia & Pain Medicine Vol. 45, No. 7 ( 2020-07), p. 505-508
    Details
    In: Regional Anesthesia & Pain Medicine, BMJ, Vol. 45, No. 7 ( 2020-07), p. 505-508
    Abstract: Tranexamic acid (TXA) has been used extensively to minimize blood loss in cardiac surgery and more recently in orthopedic surgery. Despite a generally good safety profile, an increased risk of seizures has been observed in patients with cardiac disease. However, this issue has not been adequately addressed in the orthopedic literature. Methods After institutional review board approval, we queried a large national database to identify patients who had undergone total hip and total knee arthroplasties (2012–2016). Patients were divided based on their exposure to TXA and history of seizures. The main outcome of interest was a perioperative seizure. We conducted univariable comparisons and a multivariable regression analysis to elucidate a potential independent association between TXA administration and seizures in the perioperative period (with or without a history of seizures). Results TXA was used overall in 45.9% (n=4 21 890) of joint arthroplasty recipients (n=9 18 918), with more frequent use over time. Utilization rates did not differ between those with and without a history of seizures; 42.2% (3487/8252) of patients with a seizure history received TXA. Rates of perioperative seizure were low and did not differ between those who did and did not receive TXA (0.01% vs 0.02%, p=0.11); when subgrouping patients by history of seizures, we found no difference in incidence of perioperative seizures between groups (0.06% vs 0.02%, p=0.39). Our adjusted analysis further confirmed these results. Conclusion Despite increasing TXA utilization in total joint arthroplasty, we found an overall low seizure incidence. TXA use was not associated with elevated odds of perioperative seizure, even in patients with history of seizure.
    Type of Medium: Online Resource
    ISSN: 1098-7339 , 1532-8651
    URL: Article
    URL: Article
    DOI: 10.1136/rapm-2020-101301
    DOI: 10.1136/rapm-2020-101301.supp1
    Language: English
    Publisher: BMJ
    Publication Date: 2020
    detail.hit.zdb_id: 2028901-7
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  • 2
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    Risk of chronic opioid use after simultaneous versus staged bilateral knee arthroplasty
    BMJ ; 2021
    In:  Regional Anesthesia & Pain Medicine Vol. 46, No. 5 ( 2021-05), p. 405-409
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    In: Regional Anesthesia & Pain Medicine, BMJ, Vol. 46, No. 5 ( 2021-05), p. 405-409
    Abstract: Several studies have identified excess risk associated with undergoing simultaneous (compared with unilateral or staged) bilateral total knee arthroplasty (BTKA). However, few have addressed subsequent chronic opioid use. Given the substantial morbidity and mortality associated with prolonged opioid use, we evaluated the incidence of postoperative chronic opioid use following simultaneous versus staged BTKA, based on the different timing strategies of staged procedures. Methods In this retrospective cohort study, patients who underwent BTKA procedures (2012–2016; Truven Health MarketScan; n=14 407) were classified as having undergone simultaneous or staged BTKA ( 〈 3 months, 3–6 months or 6–12 months apart). Outcomes were postoperative chronic opioid use and oral morphine equivalents prescribed on discharge. Multivariable regression models measured associations between type/timing of BTKA and outcomes. ORs and 95% CIs were reported. Results Unadjusted frequency of chronic opioid use did not differ between groups, (Simultaneous: 11.3%, staged 〈 3 months: 10.7%, staged 3–6 months: 11.7%, staged 〉 6 months: 10.2%; p=0.247). In an adjusted model, there was no significant difference in the odds of becoming chronic opioid users between staged and simultaneous BTKA (staged 〈 3 months OR 1.03, 95% CI 0.88 to 1.21/staged 3–6 months OR 0.94, 95% CI 0.79 to 1.12/staged 〉 6 months OR 0.96, 95% CI 0.82 to 1.13; p=0.755). Patients undergoing staged BTKAs 〈 6 months apart (compared with simultaneous) were prescribed slightly greater oral morphine equivalents on hospital discharge (staged 〈 3 months 6% increase, 95% CI 3% to 10%; staged 3–6 months 4%, 95% CI 1% to 8%; p=0.002). Conclusion Although patients undergoing staged BTKA 〈 6 months apart were prescribed greater quantities of opioids on discharge, there was no significant difference in the odds of postoperative chronic opioid use compared with simultaneous BTKA. The timing of BTKA procedures does not appear to influence the likelihood of postoperative chronic opioid dependence.
    Type of Medium: Online Resource
    ISSN: 1098-7339 , 1532-8651
    URL: Article
    URL: Article
    DOI: 10.1136/rapm-2020-102060
    DOI: 10.1136/rapm-2020-102060.supp1
    Language: English
    Publisher: BMJ
    Publication Date: 2021
    detail.hit.zdb_id: 2028901-7
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  • 3
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    Trends in total knee and hip arthroplasty recipients: a retrospective cohort study
    BMJ ; 2019
    In:  Regional Anesthesia & Pain Medicine Vol. 44, No. 9 ( 2019-09), p. 854-859
    Details
    In: Regional Anesthesia & Pain Medicine, BMJ, Vol. 44, No. 9 ( 2019-09), p. 854-859
    Abstract: Arthroplasty is one of the most commonly performed procedures in the USA with projections of continuous growth. As this field undergoes continuous changes, the goal of this study was to provide an analysis of patient-related and healthcare system-related trends. This is important as it allows practitioners, administrators and policy makers to allocate needed resources appropriately. Methods The study included total knee arthroplasty (TKA) and total hip arthroplasty (THA) procedures from 2006 to 2016. Demographic information, comorbidities and complications were extracted and analyzed from the Premier Healthcare database. Results The surgical volume increased annually over the observation period by an average of 5.54% for TKA and 7.02% for THA, respectively. The average age of the patient population and the types of anesthesia used remained relatively consistent over time. Comorbidity burden increased, especially for obesity (16.52% in 2006 and 29.77% in 2016 for TKA, 11.15% in 2006 and 20.92% in 2016 for THA), obstructive sleep apnea (OSA) (6.82% in 2006 and 17.03% in 2016 for TKA, 4.69% in 2006 and 12.72% in 2016 for THA) and renal insufficiency (2.81% in 2006 and 7.01% in 2016 for TKA, 2.78% in 2006 and 6.43% in 2016 for THA). Minor trends of increases were also observed in the prevalence of liver disease, depression and hypothyroidism. All postoperative complications were trending lower except for acute renal failure, where an increase was noted (4.39% in 2006 and 8.10% in 2016 for TKA, 4.99% in 2006 and 8.42% in 2016 for THA). Discussion Significant trends in the care of patients who undergo TKA and THA were identified. Individuals undergoing these procedures presented with a higher prevalence of comorbidities. Despite these trajectories, complications declined over time. These data can be used to inform future research and to allocate resources to address changes in populations cared for and complications encountered.
    Type of Medium: Online Resource
    ISSN: 1098-7339 , 1532-8651
    URL: Article
    URL: Article
    DOI: 10.1136/rapm-2019-100678
    DOI: 10.1136/rapm-2019-100678.supp1
    Language: English
    Publisher: BMJ
    Publication Date: 2019
    detail.hit.zdb_id: 2028901-7
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  • 4
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    Risk factors for new-onset depression or anxiety following total joint arthroplasty: the role of chronic opioid use
    BMJ ; 2019
    In:  Regional Anesthesia & Pain Medicine Vol. 44, No. 11 ( 2019-11), p. 990-997
    Details
    In: Regional Anesthesia & Pain Medicine, BMJ, Vol. 44, No. 11 ( 2019-11), p. 990-997
    Abstract: Several studies have evaluated the impact of preoperative depression on outcomes following total joint arthroplasty (TJA), however few have studied new-onset depression or anxiety after TJA. We aimed to identify the incidence of and risk factors for new-onset depression/anxiety after TJA, specifically focusing on the role of chronic opioid use. Methods Patients who underwent total hip (THA) or total knee (TKA) arthroplasty from 2012 to 2015 were identified from the Truven MarketScan database. The main outcomes were new-onset depression or anxiety. The main risk factor of interest was chronic opioid use as a proxy for chronic pain; this was classified into three groups: isolated preoperative use, isolated postoperative use, and preoperative use that continued postoperatively. Multivariable logistic regression models were used to obtain ORs and 95% CIs. Results Overall, 106 260 TJA procedures were included (34.3% THA/65.7% TKA); new-onset depression and anxiety were observed in 3.6% and 4.8% of patients, respectively. Preoperative chronic opioid use (6.3%; OR 1.88, 95% CI 1.47 to 2.40), isolated postoperative use (10%; OR 2.61, 95% CI 2.08 to 3.28), and continued postoperative use (7.8%; OR 2.08, 95% CI 1.74 to 2.49) were all associated with significantly increased odds of new-onset depression. Additional risk factors included female gender, younger age, comorbid psychological conditions, and hospital readmission within 6 months of surgery. Similar patterns were seen for new-onset anxiety. Discussion Given the observed relationship between chronic opioid use and adverse psychological outcomes following TJA, the relationship between these two entities requires further evaluation, specifically to identify if there is a causal relationship.
    Type of Medium: Online Resource
    ISSN: 1098-7339 , 1532-8651
    URL: Article
    URL: Article
    URL: Article
    DOI: 10.1136/rapm-2019-100785
    DOI: 10.1136/rapm-2019-100785.supp1
    DOI: 10.1136/rapm-2019-100785.supp2
    Language: English
    Publisher: BMJ
    Publication Date: 2019
    detail.hit.zdb_id: 2028901-7
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  • 5
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    Ultrasound guidance for peripheral nerve blocks: an observational trend study of national data
    BMJ ; 2020
    In:  Regional Anesthesia & Pain Medicine Vol. 45, No. 9 ( 2020-09), p. 681-683
    Details
    In: Regional Anesthesia & Pain Medicine, BMJ, Vol. 45, No. 9 ( 2020-09), p. 681-683
    Type of Medium: Online Resource
    ISSN: 1098-7339 , 1532-8651
    URL: Article
    DOI: 10.1136/rapm-2019-101113
    Language: English
    Publisher: BMJ
    Publication Date: 2020
    detail.hit.zdb_id: 2028901-7
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  • 6
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    Lack of July effect in the utilization of neuraxial and peripheral nerve block in US teaching hospitals: a retrospective analysis
    BMJ ; 2020
    In:  Regional Anesthesia & Pain Medicine Vol. 45, No. 5 ( 2020-05), p. 357-361
    Details
    In: Regional Anesthesia & Pain Medicine, BMJ, Vol. 45, No. 5 ( 2020-05), p. 357-361
    Abstract: Given the steep learning curve for neuraxial and peripheral nerve blocks, utilization of general anesthesia may increase as new house staff begin their residency programs. We sought to determine whether “July effect” affects the utilization of neuraxial anesthesia, peripheral nerve blocks, and opioid prescribing for lower extremity total joint arthroplasties (TJA) in July compared with June in teaching and non-teaching hospitals. Methods Neuraxial anesthesia, peripheral nerve block use, and opioid prescribing trends were assessed using the Premier database (2006–2016). Analyses were conducted separately for teaching and non-teaching hospitals. Differences in proportions were evaluated via χ 2 test, while differences in opioid prescribing were analyzed via Wilcoxon rank-sum tests. Results A total of 1 723 256 TJA procedures were identified. The overall proportion of neuraxial anesthesia use in teaching hospitals was 14.4% in both June and July (p=0.940). No significant changes in neuraxial use were seen in non-teaching hospitals (24.5% vs 24.9%; p=0.052). Peripheral nerve block utilization rates did not differ in both teaching (15.4% vs 15.3%; p=0.714) and non-teaching hospitals (10.7% vs 10.5%; p=0.323). Overall median opioid prescribing at teaching hospitals changed modestly from 262.5 oral morphine equivalents (OME) in June to 260 in July (p=0.026) while median opioid prescribing remained at a constant value of 255 OME at non-teaching hospitals (p=0.893). Conclusion Utilization of neuraxial and regional anesthesia techniques was not affected during the initial transition period of new house staff in US teaching institutions. It is feasible that enough resources are available in the system to accommodate periods of turnover and maintain levels of regional anesthetic care including additional attending anesthesiologist oversight.
    Type of Medium: Online Resource
    ISSN: 1098-7339 , 1532-8651
    URL: Article
    URL: Article
    URL: Article
    URL: Article
    URL: Article
    DOI: 10.1136/rapm-2020-101318
    DOI: 10.1136/rapm-2020-101318.supp1
    DOI: 10.1136/rapm-2020-101318.supp2
    DOI: 10.1136/rapm-2020-101318.supp3
    DOI: 10.1136/rapm-2020-101318.supp4
    Language: English
    Publisher: BMJ
    Publication Date: 2020
    detail.hit.zdb_id: 2028901-7
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