Epidemiology of Contact Lens-Related Emergency Department Visits: Data From Nationwide Emergency Department Sample.

PURPOSE: The purpose of this retrospective longitudinal cohort study was to determine the epidemiology of contact lens-related visits to the emergency department at a national level and identify high-risk groups. METHODS: National emergency department (ED) sample, a representative sample of all US EDs, was used to determine the incidence and characteristics of keratitis in contact lens users presenting to the ED from 2006 to 2017. ICD-9-CM and ICD-10-CM codes for corneal disorder due to contact lens use (371.82 and H1882) were used to identify the patients. RESULTS: A total of 149,716 ED visits were recorded with a diagnosis of corneal disorder due to contact lens use. Incidence of ED visits with contact lens-related corneal disorder declined steadily from 2010 to 2016. In total, 67% of the patients were female, 68.9% were adults aged 19 to 44 years, and 56.3% had a private insurance provider. The most common diagnosis at the time of discharge was "eye discharge" or "redness" (10.9%), followed by "corneal ulcer" (3.6%). Patients of highest income quartiles were more likely to present to the ED with contact lens-related corneal disorders (adjusted odds ratio, 1.21, 95% confidence interval 1.15-1.27) compared with low-income quartile. Among those who were discharged from the ED, the average charge per patient was $1051.4 (SD = 795.4). CONCLUSIONS: Women, young adults, and patients belonging to higher socioeconomic status were found to have higher prevalence of contact lens-related corneal ED visits. Identification of high-risk groups will help in the prevention of further corneal complications and the associated vision loss.

Obstetric pain management for pregnant women with opioid use disorder: A qualitative and quantitative comparison of patient and provider perspectives (QUEST study).

BACKGROUND AND AIM: Patients with opioid use disorder (OUD) may experience inadequate pain management especially during childbirth. This study assessed and compared patient and provider perspectives on analgesia during and after delivery in women with OUD. DESIGN: Prospective cohort, mixed method design including semi-structured interviews and structured surveys with pregnant or recently pregnant patients (n = 17) and provider (n = 15) groups. SETTING: Prenatal clinics and hospital postpartum units. PARTICIPANTS: Patients were pregnant women with OUD currently treated with methadone (n = 1) or buprenorphine (n = 16). Providers were obstetricians (n = 5), obstetric nurses (n = 5) and anesthesiologists (n = 5). MEASUREMENTS: Validated questionnaires were completed by both groups; patient interviews were conducted during the third trimester and at 5 days post-delivery. Patient topics included pain management preferences, analgesia satisfaction and attitudes toward pain. Provider topics included labor and postpartum pain management perspectives. Interviews were independently coded and qualitatively analyzed for major themes. FINDINGS: Five major themes emerged from patient interviews: (1) neuraxial blockade was endorsed for labor pain; (2) otherwise, limited pain control options were perceived; (3) no consensus around use of opioids for pain; (4) non-opioid options should be available; and (5) provider communication and health-care system issues act as barriers to adequate pain management. Provider perspective themes included the following: (1) unique challenges in pain management for patients with OUD; (2) confusion on how to plan for and make perinatal adjustments to medication for OUD; (3) discrepant views on use of opioids for pain management; (4) endorsement of non-pharmacological and non-opioid options; and (5) need for improved provider collaboration in developing pain management plans. CONCLUSIONS: Patients with opioid use disorder and health-care providers prioritize pain management during and after childbirth, but have discrepant views on use of opioids and other pain management options. Inadequate care coordination and discrepancies in opinions need to be addressed both within care teams and between patients and providers. Clinicians would benefit from better evidence to guide clinical care of patients with OUD for patient-centered pain management.

Impact of Perioperative Neurologic Deficits on Clinical Outcomes After Posterior Cervical Fusion.

BACKGROUND: In the United States, the number of posterior cervical fusions has increased substantially. Perioperative neurologic complications associated with this procedure, such as spinal cord and peripheral nerve injuries, can have significant effects on patient health. We examined the impact of perioperative neurologic deficits on mortality in patients undergoing posterior cervical fusion. The secondary aim was to understand the risk factors for perioperative neurologic complications. METHODS: Data were collected from the National Inpatient Sample (NIS) Health Cost Utilization Project (HCUP) between 1999 and 2011. Patients younger than 18 years and older than 80 years were excluded, as were patients who underwent posterior cervical fusion caused by trauma. Patient demographics and comorbidities were compiled as well as variables that have been associated with increased risk of perioperative neurologic deficits. We used the van Walraven score, a weighted numeric surrogate for the Elixhauser comorbidity index, as a covariate to assess comorbidities that have been associated with in-hospital mortality and morbidity after posterior cervical fusion. In addition, we performed univariate comparisons between covariates and surgical outcomes. We conducted a multivariable logistic regression, adjusting for many of the covariates, as well as trend analyses. RESULTS: An analysis of 33,644 patients yielded an overall rate of perioperative neurologic deficits, morbidity, and mortality of 1.08%, 40.44%, and 1.00%, respectively. Perioperative neurologic deficits were independent risk factors predictors of in-hospital mortality (odds ratio, 5.270; P < 0.0001) and morbidity (odds ratio, 2.579; P < 0.0001). Other statistically significant predictors of mortality included increasing van Walraven score, myocardial infarction, metastatic cancer, and weight loss. These were also independent predictors of morbidity along with but not limited to age, device complications, congestive heart failure, paralysis, diabetes with chronic complications, deficiency anemias, device complications, and intraspinal abscess. CONCLUSIONS: Perioperative neurologic deficits are serious complications of posterior cervical fusion and can independently predict in-hospital mortality and morbidity. As this procedure continues to be used increasingly, attention should be directed toward preventing these complications and intervening earlier in patients who have a neurologic deficit. Future efforts should be geared toward screening for at-risk patients with the initiation of surgical prehabilitation.