Publications by authors named "Alex Illescas"
Although the coexistence of cervical and lumbar spinal conditions is fairly common, surgical treatments are usually staged, even though simultaneous fusion of the cervical and lumbar spine may be a viable option for appropriate candidates. We sought to investigate the outcomes of staged vs simultaneous cervical and lumbar fusions in terms of differences in postoperative complications and resource use. We performed a retrospective cohort study using claims data from the 2006 to 2020 all-payer Premier Health Database.
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- A study analyzed data from over 1.3 million hysterectomies from 2006 to 2022 to assess the effects of multimodal analgesia on postoperative complications and opioid prescriptions.* -
- Results showed that 84.3% of patients received multimodal analgesia, which significantly lowered the odds of complications, reduced opioid prescriptions, and shortened hospital stays.* -
- Findings highlight the effectiveness of combining opioids with non-opioid pain relievers, leading to fewer serious complications, less opioid use, and lower healthcare costs.*
Article Synopsis
- - The study examined trends in patient characteristics and outcomes for hip fracture repair surgeries in the USA from 2016 to 2021, focusing on data from a large healthcare dataset.
- - Key findings included a slight decline in median patient age, a decrease in the proportion of female patients, and an increase in patients with multiple comorbidities, although the overall complication rates showed a downward trend.
- - General anesthesia remained the most common type used for these surgeries, but its usage overall decreased, while internal fixation procedures also saw a decline in frequency over the study period.
Article Synopsis
- A study reviewed the impact of neuraxial anesthesia versus general anesthesia on outcomes for patients undergoing total hip/knee arthroplasty (THA/TKA) over a period from 2006 to 2021, as practices and usage shifted towards neuraxial.
- Data from the Premier Healthcare Database showed increased use of neuraxial anesthesia and demonstrated lower rates of adverse outcomes, like renal failure and need for blood transfusions, particularly from 2016 to 2021 compared to 2006 to 2015.
- The results reaffirmed earlier findings, highlighting the lasting advantages of using neuraxial anesthesia in orthopedic surgeries.
Article Synopsis
- Timely surgical treatment for hip fractures is critical, with guidelines recommending surgery within 24-48 hours of admission.
- A study of over 500,000 hip fracture patients revealed that those who had surgery on days 2 or 3 after admission faced higher risks of major complications, mortality, and ICU admission compared to those who had surgery on day 0-1.
- The findings emphasize the need for adherence to surgical timing guidelines, highlighting ongoing challenges in balancing patient optimization and timely intervention, suggesting further research is necessary.
Article Synopsis
- This study investigates how chronological age affects the risk of complications after total knee arthroplasty (TKA), focusing on balancing patient health and disability to minimize issues during surgery.
- An analysis of over 2 million TKA patients found that while patient health (measured by the Charlson-Deyo Comorbidity Index) was more strongly linked to complications than age itself, those over 80 showed a significant increase in risks for various complications compared to younger patients.
- The findings suggest that even healthier elderly patients can face higher complication risks after age 80, which could help inform decisions about TKA, especially as surgeries move more to outpatient settings.
Background: Residual neuromuscular blockade after surgery remains a major concern given its association with pulmonary complications. However, current clinical practices with and the comparative impact on perioperative risk of various reversal agents remain understudied.
Objective: We investigated the use of sugammadex and neostigmine in the USA, and their impact on postoperative complications by examining national data.
Objective: Multimodal pain management aims to concurrently target several pain pathways for improved treatment efficacy and recovery. We investigated associations between multimodal analgesia use and postoperative complications, length of hospital stay (LOS), and opioid consumption among patients undergoing coronary artery bypass graft surgery.
Methods: This retrospective cohort study included 349,940 adult patients undergoing elective coronary artery bypass graft surgery (January 2006 to December 2019), from the national Premier Healthcare claims dataset.
Background: Various studies have demonstrated racial disparities in perioperative care and outcomes. The authors hypothesize that among lower extremity total joint arthroplasty patients, evidence-based perioperative practice utilization increased over time among all racial groups, and that standardized evidence-based perioperative practice care protocols resulted in reduction of racial disparities and improved outcomes.
Methods: The study analyzed 3,356,805 lower extremity total joint arthroplasty patients from the Premier Healthcare database (Premier Healthcare Solutions, Inc.
Introduction: Liposomal bupivacaine has been marketed for the achievement of long-acting local or regional anesthesia after major lower extremity total joint arthroplasty. However, it is comparatively expensive and controversy remains regarding its ability to decrease healthcare costs. With mounting evidence suggesting non-superiority in efficacy, compared with plain bupivacaine, we sought to investigate trends in liposomal bupivacaine use and identify changes in practice.
View Article and Find Full Text PDFStudy Objective: To analyze the use of neuraxial techniques in total hip or knee arthroplasty patients who previously underwent lumbar spine surgeries.
Design: Retrospective analysis of a national database.
Setting: U.
Introduction: A large body of literature suggests that peripheral nerve blockade (PNB) is associated with improved perioperative outcomes in total hip and knee joint arthroplasty patients. However, it is unclear to what extent this association exists across patient subgroups based on age and health status.
Methods: Patients who underwent total joint arthroplasty were identified from the Premier Healthcare database (2006-2019).
Objectives: There is a lack of data on the distribution of women first and senior authorships in pain journals. Using articles published in top North American pain journals over the past two decades, we sought to describe the prevalence and changes in women representation among first and last authors.
Methods: We retrieved all published research articles in four pain journals (Regional Anesthesia and Pain Medicine, Clinical Journal of Pain, Pain and The Journal of Pain) from 2002 to 2021 using the easyPubMed package.
Article Synopsis
- This study examines the accuracy of hospital documentation for total knee and hip arthroplasty implants, revealing a wide disparity in performance among different hospitals, categorized into five tiers from Platinum (best) to Poor (worst).
- The research showed a strong correlation between documentation performance for TKA and THA, suggesting that hospitals either excel or struggle significantly in these areas.
- Teaching hospitals were found to have less satisfactory documentation compared to non-teaching facilities, while overall, the quality of documentation for endovascular stents was better than for TKA/THA procedures.
Background: Surgical patients with preexisting neurological diseases create greater challenges to perioperative management, and choice of anesthetic is often complicated. We investigated neuraxial anesthesia use in total knee and hip arthroplasty (TKA/THA) recipients with multiple sclerosis or myasthenia gravis compared to the general population.
Methods: We retrospectively analyzed patients undergoing a TKA/THA with a diagnosis of multiple sclerosis or myasthenia gravis (Premier Health Database, 2006-2019).
Study Objective: Acetaminophen (APAP) and intravenous acetaminophen (IVAPAP) has been proposed as a part of many opioid-sparing multimodal analgesic pathways. The aim of this analysis was to compare the effectiveness of IVAPAP with oral APAP on opioid utilization and opioid-related adverse effects.
Design: Retrospective study of population-based database.
Background And Aims: The onset of the coronavirus 2019 (COVID-19) pandemic brought together the American Society of Regional Anesthesia and Pain Medicine (ASRA) and the European Society of Regional Anaesthesia and Pain Therapy (ESRA) to release a joint statement on anesthesia use. Their statement included a recommendation to use regional anesthesia whenever possible to mitigate the risk associated with aerosolizing procedures. We sought to examine the utilization of anesthesia in pediatric patients undergoing a surgical procedure for fractures or ligament repairs before and during COVID-19.
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