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1.
Anesthesiology ; 138(5): 462-476, 2023 05 01.
Article in English | MEDLINE | ID: mdl-36692360

ABSTRACT

BACKGROUND: There is insufficient prospective evidence regarding the relationship between surgical experience and prolonged opioid use and pain. The authors investigated the association of patient characteristics, surgical procedure, and perioperative anesthetic course with postoperative opioid consumption and pain 3 months postsurgery. The authors hypothesized that patient characteristics and intraoperative factors predict opioid consumption and pain 3 months postsurgery. METHODS: Eleven U.S. and one European institution enrolled patients scheduled for spine, open thoracic, knee, hip, or abdominal surgery, or mastectomy, in this multicenter, prospective observational study. Preoperative and postoperative data were collected using patient surveys and electronic medical records. Intraoperative data were collected from the Multicenter Perioperative Outcomes Group database. The association between postoperative opioid consumption and surgical site pain at 3 months, elicited from a telephone survey conducted at 3 months postoperatively, and demographics, psychosocial scores, pain scores, pain management, and case characteristics, was analyzed. RESULTS: Between September and October 2017, 3,505 surgical procedures met inclusion criteria. A total of 1,093 cases were included; 413 patients were lost to follow-up, leaving 680 (64%) for outcome analysis. Preoperatively, 135 (20%) patients were taking opioids. Three months postsurgery, 96 (14%) patients were taking opioids, including 23 patients (4%) who had not taken opioids preoperatively. A total of 177 patients (27%) reported surgical site pain, including 45 (13%) patients who had not reported pain preoperatively. The adjusted odds ratio for 3-month opioid use was 18.6 (credible interval, 10.3 to 34.5) for patients who had taken opioids preoperatively. The adjusted odds ratio for 3-month surgical site pain was 2.58 (1.45 to 4.4), 4.1 (1.73 to 8.9), and 2.75 (1.39 to 5.0) for patients who had site pain preoperatively, knee replacement, or spine surgery, respectively. CONCLUSIONS: Preoperative opioid use was the strongest predictor of opioid use 3 months postsurgery. None of the other variables showed clinically significant association with opioid use at 3 months after surgery.


Subject(s)
Breast Neoplasms , Opioid-Related Disorders , Humans , Female , Analgesics, Opioid/adverse effects , Prospective Studies , Pain, Postoperative/drug therapy , Mastectomy , Opioid-Related Disorders/drug therapy , Anesthesia, General
2.
Anesth Analg ; 130(6): 1702-1708, 2020 06.
Article in English | MEDLINE | ID: mdl-31986126

ABSTRACT

To study the impact of anesthesia opioid-related outcomes and acute and chronic postsurgical pain, we organized a multicenter study that comprehensively combined detailed perioperative data elements from multiple institutions. By combining pre- and postoperative patient-reported outcomes with automatically extracted high-resolution intraoperative data obtained through the Multicenter Perioperative Outcomes Group (MPOG), the authors sought to describe the impact of patient characteristics, preoperative psychological factors, surgical procedure, anesthetic course, postoperative pain management, and postdischarge pain management on postdischarge pain profiles and opioid consumption patterns. This study is unique in that it utilized multicenter prospective data collection using a digital case report form integrated with the MPOG framework and database. Therefore, the study serves as a model for future studies using this innovative method. Full results will be reported in future articles; the purpose of this article is to describe the methods of this study.


Subject(s)
Analgesics, Opioid/therapeutic use , Analgesics/therapeutic use , Chronic Pain/therapy , Pain Management/methods , Pain, Postoperative/drug therapy , Anxiety/complications , Anxiety/diagnosis , Depression/complications , Depression/diagnosis , Humans , Opioid-Related Disorders/prevention & control , Pain Measurement , Postoperative Period , Prospective Studies , Self Report , Surveys and Questionnaires , Treatment Outcome
3.
Plast Reconstr Surg ; 138(6): 1171-1178, 2016 Dec.
Article in English | MEDLINE | ID: mdl-27879583

ABSTRACT

BACKGROUND: The purpose of this study was to evaluate breast tissue expanders with magnetic ports for safety in patients undergoing abdominal/pelvic magnetic resonance angiography before autologous breast reconstruction. METHODS: Magnetic resonance angiography of the abdomen and pelvis at 1.5 T was performed in 71 patients in prone position with tissue expanders with magnetic ports labeled "MR Unsafe" from July of 2012 to May of 2014. Patients were monitored during magnetic resonance angiography for tissue expander-related symptoms, and the chest wall tissue adjacent to the tissue expander was examined for injury at the time of tissue expander removal for breast reconstruction. Retrospective review of these patients' clinical records was performed. T2-weighted fast spin echo, steady-state free precession and gadolinium-enhanced spoiled gradient echo sequences were assessed for image artifacts. RESULTS: No patient had tissue expander or magnetic port migration during the magnetic resonance examination and none reported pain during scanning. On tissue expander removal (71 patients, 112 implants), the surgeons reported no evidence of tissue damage, and there were no operative complications at those sites of breast reconstruction. CONCLUSION: Magnetic resonance angiography of the abdomen and pelvis in patients with certain breast tissue expanders containing magnetic ports can be performed safely at 1.5 T for pre-autologous flap breast reconstruction perforator vessel mapping. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Subject(s)
Magnetic Resonance Angiography/adverse effects , Magnets/adverse effects , Mammaplasty/methods , Preoperative Care , Tissue Expansion Devices/adverse effects , Tissue Expansion/instrumentation , Abdomen/blood supply , Abdomen/diagnostic imaging , Adult , Female , Humans , Middle Aged , Outcome Assessment, Health Care , Pelvis/blood supply , Pelvis/diagnostic imaging , Retrospective Studies , Surgical Flaps/blood supply , Tissue Expansion/methods
5.
Int J Pediatr Otorhinolaryngol ; 77(10): 1683-8, 2013 Oct.
Article in English | MEDLINE | ID: mdl-23962764

ABSTRACT

OBJECTIVES: The objective of this study is to analyze the epidemiological, clinical, radiological and endoscopic characteristics of pediatric foreign body aspiration in Algeria. METHODS: In this retrospective study, the results of 2624 children younger than 18 years admitted in our department for respiratory foreign body removal between 1989 and 2012, were presented. Most of them had an ambulatory rigid bronchoscopy. RESULTS: The children (62.34% males and 37.65% females) were aged 4 months to 18 years with 66% between 1 and 3 years. Choking was related in 65% of cases. The delay between aspiration and removal was 2-8 days in 65.8% and within 24 h in 9.2%. In the most cases, the children arrived with cough, laryngeal or bronchial signs and unilateral reduction of vesicular murmur. The examination was normal in 13%. The most common radiologic finding was pulmonary air trapping (40.7%). The aspirated bodies were organic in 66.7%, dominated by peanuts, while sunflower seeds, beans and ears of wheat were the most dangerous. In the other cases, they were metallic or plastic as pen caps and recently scarf pins. The endoscopic removal by rigid bronchoscopy was successful and complete in 97%. Cases with extraction failure (3%) limited to certain FBs, all of them inorganic were assigned to surgery. The complications related to the endoscopic procedure were 0.29% with a mortality of 0.26%. CONCLUSION: Foreign body aspiration is a real public health problem in Algeria. The best way to manage it is an early diagnosis and a rigid bronchoscopy removal under general anesthesia used by fully trained staff. The prevention of this domestic accident should consider the population lifestyle and cultural habits to be more effective.


Subject(s)
Bronchi , Bronchoscopy/methods , Foreign Bodies/epidemiology , Foreign Bodies/surgery , Foreign-Body Reaction/surgery , Granuloma, Foreign-Body/surgery , Adolescent , Age Distribution , Airway Obstruction/diagnosis , Airway Obstruction/etiology , Algeria/epidemiology , Child , Child, Preschool , Cohort Studies , Female , Follow-Up Studies , Foreign Bodies/diagnostic imaging , Foreign-Body Reaction/diagnosis , Foreign-Body Reaction/epidemiology , Granuloma, Foreign-Body/diagnosis , Granuloma, Foreign-Body/epidemiology , Humans , Incidence , Infant , Male , Respiratory Aspiration/diagnosis , Respiratory Aspiration/surgery , Retrospective Studies , Risk Assessment , Severity of Illness Index , Sex Distribution , Tomography, X-Ray Computed/methods , Treatment Outcome
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