Primary objective: The purpose of this paper is to review the clinical and research utility and applications of blood, cerebrospinal fluid (CSF), and cerebral microdialysis biomarkers in traumatic ...

https://www.tandfonline.com/doi/pdf/10.1080/02699052.2017.1357836

Biofluid biomarkers of traumatic brain injury

Study Design.Retrospective, economic analysis.Objective.To study patient profile associated with preoperative chronic opioid therapy (COT), and study COT as a risk factor for 90-day complications, emergency department (ED) visits, and readmission after primary one- to two-level posterior lumbar fusi

Preoperative Chronic Opioid Therapy: A Risk Factor for Complications, Readmission, Continued Opioid Use and Increased Costs After One- and Two-Level Posterior Lumbar Fusion.

Importance Prolonged opioid use after surgery may be associated with opioid dependency and increased health care use However, published studies have reported varying estimates of the magnitude of prolonged opioid use and risk factors associated with the transition of patients to long-term opioid use Objectives To evaluate the rate and characteristics of patient-level risk factors associated with increased risk of prolonged use of opioids after surgery Data Sources For this systematic review and meta-analysis, a search of MEDLINE, Embase, and Google Scholar from inception to August 30, 2017, was performed, with an updated search performed on June 30, 2019 Key words may includeopioid analgesics, general surgery, surgical procedures, persistent opioid use,andpostoperative pain Study Selection Of 7534 articles reviewed, 33 studies were included Studies were included if they involved participants 18 years or older, evaluated opioid use 3 or more months after surgery, and reported the rate and adjusted risk factors associated with prolonged opioid use after surgery Data Extraction and Synthesis The Meta-analysis of Observational Studies in Epidemiology (MOOSE) and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines were followed Two reviewers independently assessed and extracted the relevant data Main Outcomes and Measures The weighted pooled rate and odds ratios (ORs) of risk factors were calculated using the random-effects model Results The 33 studies included 1 922 743 individuals, with 1 854 006 (964%) from the US In studies with available sex and age information, participants were mostly female (1 031 399; 827%) and had a mean (SD) age of 593 (128) years The pooled rate of prolonged opioid use after surgery was 67% (95% CI, 45%-98%) but decreased to 12% (95% CI, 04%-39%) in restricted analyses involving only opioid-naive participants at baseline The risk factors with the strongest associations with prolonged opioid use included preoperative use of opioids (OR, 532; 95% CI, 294-964) or illicit cocaine (OR, 434; 95% CI, 150-1258) and a preoperative diagnosis of back pain (OR, 205; 95% CI, 163-258) No significant differences were observed with various study-level factors, including a comparison of major vs minor surgical procedures (pooled rate: 70%; 95% CI, 49%-99% vs 111%; 95% CI, 60%-194%;P = 20) Across all of our analyses, there was substantial variability because of heterogeneity instead of sampling error Conclusions and Relevance The findings suggest that prolonged opioid use after surgery may be a substantial burden to public health It appears that strategies, such as proactively screening for at-risk individuals, should be prioritized

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Rate and Risk Factors Associated With Prolonged Opioid Use After Surgery: A Systematic Review and Meta-analysis

Background:Preoperative opioid use is known to increase the likelihood of complications and inferior outcomes following spine surgery. We evaluated the association of preoperative opioid use and other risk factors with postoperative opioid use.Methods:We queried 2006-2014 TRICARE insurance claims to

Sustained Preoperative Opioid Use Is a Predictor of Continued Use Following Spine Surgery.

Background Our country is in the midst of an opioid epidemic. Although the problem is multifactorial, one issue is the presence of excess prescription opioid medications circulating in our communities. Our objective was to determine whether dissemination of an educational brochure would improve the disposal of unused opioids after surgery. Study Design Eligible surgery patients from an upper extremity/peripheral nerve clinic were enrolled into this prospective before and after study between February 2017 and September 2017. Patients who reported opioid use preoperatively were excluded from this study. The same survey was administered to the group of patients who did not receive the intervention and to those who did receive the intervention. Our primary endpoint was the proportion of patients who disposed of unused opioid medications. Results A total of 334 patients were studied: 164 who did not receive the brochure and 170 who received the brochure. Seventy-six patients were excluded for preoperative opioid use. After dissemination of the brochure, there was a significant increase in the proportion of patients who disposed of their unused opioids (11% vs 22%, p = 0.02). Of those who disposed of their opioids, there was no significant difference in the proportion of patients from each group who disposed in a manner that was recommended by the brochure (43% vs 64%, p = 0.19). Conclusions Dissemination of the educational brochure improved disposal of unused opioids after surgery. This low-cost, easily implemented intervention can improve disposal of unused opioids and ultimately, decrease the amount of excess opioids circulating in our communities.

Empowering Post-Surgical Patients to Improve Opioid Disposal: A Before and After Quality Improvement Study

Mild traumatic injuries to the brain (e.g., concussion) are common and have been recognized since antiquity, although definitions have varied historically. Nonetheless, studying the epidemiology of concussion helps clarify the overall importance, risk factors, and at-risk populations for this injury. The present review will focus on recent findings related to the epidemiology of concussion including definition controversies, incidence, and patterns in the population overall and in the military and athlete populations specifically. Finally, as this is an area of active research, we will discuss how future epidemiologic observations hold promise for gaining greater clarity about concussion and mild traumatic brain injury.

Update on the Epidemiology of Concussion/Mild Traumatic Brain Injury.

Study Design.A population-based retrospective cohort study.Objective.The aim of this study was to examine risk factors for long-term opioid use following lumbar spinal fusion surgery in a nationally representative cohort of commercially insured adults.Summary of Background Data.Opioid prescription r

/pdf/predictors-of-long-term-opioid-use-following-lumbar-fusion-5cma9nuw70.pdf

Joseph Connolly

Papers

Update on the Epidemiology of Concussion/Mild Traumatic Brain Injury.

Predictors of Long-term Opioid Use Following Lumbar Fusion Surgery.