Trends in opioid use following balloon kyphoplasty or vertebroplasty for the treatment of vertebral compression fractures.

This retrospective analysis of insurance claims evaluated real-world trends in prescription fills among patients treated with balloon kyphoplasty (N = 6,656) or vertebroplasty (N = 2,189) following diagnosis of vertebral compression fracture. Among those with evidence of opioid use, nearly half of patients discontinued or reduced prescription fills relative to pre-operative levels. INTRODUCTION: Vertebral compression fractures (VCF) are associated with debilitating pain, spinal misalignment, increased mortality, and increased healthcare-resource utilization in elderly patients. This study evaluated the effect of balloon kyphoplasty (BKP) or vertebroplasty (VP) on post-procedure opioid prescription fills and payer costs in patients with VCF. METHODS: This was a retrospective analysis of a large, nationally representative insurance-claims database. Clinical characteristics, opioid prescription patterns, and payer costs for subjects who underwent either BKP or VP to treat VCF were evaluated beginning 6 months prior to surgery through 7-month follow-up that included a 30-day, postoperative medication washout. Patient demographics, changes in opioid utilization, and payer costs were analyzed. RESULTS: A total of 8,845 patients met eligibility criteria (75.3% BKP and 24.7% VP) with a mean of age 77 and 74% female. Among the 75% of patients who used opioids, 48.7% of patients discontinued opioid medication and 8.4% reduced prescription fills versus preoperative baseline. Patients who reduced or discontinued prescriptions exhibited a decrease in all-cause payer costs relative to pre-intervention levels, which was a significantly greater change relative to patients with no change, increase, or new start of opioids. CONCLUSIONS: Interventional treatment for VCF was associated with decreased or discontinued opioid prescription fills and reduced payer costs in follow-up in a significant proportion of the study population. Reduction of opioid-based harms may represent a previously unrecognized benefit of vertebral augmentation for VCF, especially in this elderly and medically fragile population.

Nanostructured multifunctional electromagnetic materials from the guest-host inorganic-organic hybrid ternary system of a polyaniline-clay-polyhydroxy iron composite: preparation and properties.

A nanostructured electromagnetic polyaniline-polyhydroxy iron-clay composite (PPIC) was prepared by oxidative radical emulsion polymerization of aniline in the presence of polyhydroxy iron cation (PIC) intercalated clays. Morphological observation through SEM, TEM, and AFM suggested the formation of self-assembled nanospheres of PIC with self-assembled PANI engulfed over PIC, and the presence of iron in PPIC was confirmed by the EDS analysis. XRD studies revealed that PPIC are comprised of exfoliated clay layers with PIC in the distorted spinel structure. Magnetic property measurements showed that saturation magnetization increased from 7.3 x 10(-3) to 2.5 emu/g upon varying the amount of PHIC content from 0 to 10%. Electrical conductivity measurements with the same composition were observed to be in the range of 3.0 x 10(-2) to 1.1 S/cm. Thermal stability studies using TGA in combination with DTG suggested that PPICs were thermally stable up to 350 degrees C. The interaction among clay layers, PIC, and PANI chains in PPIC were manifested from the studies made by FTIR and DSC analysis. The prospects for the direct application of this material are developing low-cost chemical sensors and also processable electromagnetic interference shielding materials for high technological applications.