Association between Initial Opioid Prescription and Patient Pain with Continued Opioid Use among Opioid-Naïve Patients Undergoing Elective Surgery in a Large American Health System.

There is growing concern about the over-prescription of opioids and the risks of long-term use. This study examined the relationship between initial need (pre-operative, post-operative, and discharge pain) and dosage of opioids in the first prescription after surgery with continued opioid use through opioid refills over 12 months, while considering patient-level characteristics. A total of 9262 opioid-naïve patients underwent elective surgery, 7219 of whom were prescribed opioids following surgery.

Evaluation of Policies Limiting Opioid Exposure on Opioid Prescribing and Patient Pain in Opioid-Naive Patients Undergoing Elective Surgery in a Large American Health System.

Objectives: Overprescribing to opioid-naive surgical patients substantially contributes to opioid use disorders, which have become increasingly prevalent. Opioid stewardship programs (OSPs) within healthcare settings provide an avenue for introducing interventions to regulate prescribing. This study examined the association of OSP policies limiting exposure on changes in surgery-related opioid prescriptions and patient pain.

Multilevel predictors of guideline concordant needle biopsy use for non-metastatic breast cancer.

Purpose: Persistent breast cancer disparities, particularly geographic disparities, may be explained by diagnostic practice patterns such as utilization of needle biopsy, a National Quality Forum-endorsed quality metric for breast cancer diagnosis. Our objective was to assess the relationship between patient- and facility-level factors and needle biopsy receipt among women with non-metastatic breast cancer in the United States.

Methods: We examined characteristics of women diagnosed with breast cancer between 2004 and 2015 in the National Cancer Database.

Clinical Work Intensity Among Medical Oncologists Practicing in National Community Oncology Research Program Community Sites.

Purpose: This study (1) assesses the level of clinical work intensity medical oncologists and oncologic nurse practitioners experience providing care and (2) identifies patient, provider, and practice factors mediating intensity.

Patients And Methods: Seventeen medical oncologists (12 physicians and five nurse practitioners) from five national sites national reported on the level of work intensity associated with 339 patient visits. Data collection at each site occurred over a 2- to 6 week period; for each provider, five visits were randomly selected from each of 4 randomly selected clinic days, yielding 20 visits per provider.

The impact of the American College of Surgeons Oncology Group (ACOSOG) Z0011 trial: An institutional review.

Background: Axillary dissection (AD) was historically recommended for all patients with breast tumor involvement discovered by sentinel lymph node biopsy (+SLNB). However, after the ACOSOG Z0011 trial, omission of AD became the recommendation for selected patients with a +SLNB. We report the impact of ACOSOG Z0011 on the completion AD rate in patients with +SLNB at our institution.

Implementing High-Value Care.

Objectives: Our objectives were to assess physician knowledge of costs of products, tests, and services commonly used by obstetrician/gynecologists (OB/GYNs) and identify those items that could be eliminated without decreasing quality of care by performing a prospective observational pilot study.

Methods: An anonymous electronic survey was distributed to 70 OB/GYN providers at Greenville Memorial Hospital. Survey items included common laboratory tests, medications, and clinical services.

Cost-effectiveness of Bariatric Surgery: Increasing the Economic Viability of the Most Effective Treatment for Type II Diabetes Mellitus.

There has been considerable debate on the cost-effectiveness of bariatric surgery within larger population groups. Despite the recognition that morbid obesity and its comorbidities are best treated surgically, insurance coverage is not universally available. One of the more costly comorbidities of obesity is Type II diabetes mellitus (T2DM).

Continuing routine cardiac surveillance in long-term use of pegylated liposomal doxorubicin: is it necessary?

Objective: The objective of this study was to determine the cardiac safety of high cumulative doses of pegylated liposomal doxorubicin (PLD) in patients with gynecologic malignancies and the need for routine evaluation of left ventricular ejection fraction (LVEF).

Methods: Data were collected for all patients treated with PLD with at least one evaluation of LVEF with either Multi-Gated Acquisition (MUGA) scan or echocardiogram from January 2006 to May 2012. Evaluation of LVEF was used to detect PLD-related cardiac toxicity (defined as a decline in LVEF of greater than 10% compared to baseline measurements).

Bariatric surgery is associated with a reduction in major macrovascular and microvascular complications in moderately to severely obese patients with type 2 diabetes mellitus.

Background: Bariatric surgery (BAR) has been established as an effective treatment for type 2 diabetes mellitus (T2DM) in obese patients. However, few studies have examined the mid- to long-term outcomes of bariatric surgery in diabetic populations. Specifically, no comparative studies have broadly examined major macrovascular and microvascular complications in bariatric surgical patients vs similar, nonbariatric surgery controls.

New-onset congestive heart failure with gemcitabine in ovarian and other solid cancers.

Objective: To assess clinical features that may predispose individuals taking gemcitabine to new-onset congestive heart failure.

Methods: A retrospective chart review was conducted with 156 female patients, 51 with ovarian cancer and 105 with breast, lung, pancreas, and bladder cancer, all of whom had received gemcitabine. Patients with new-onset congestive heart failure were compared with patients without new-onset congestive heart failure with the use of Wilcoxon rank-sum test for continuously distributed data and the Fisher exact test for proportions.

Bariatric surgery is associated with a reduced risk of mortality in morbidly obese patients with a history of major cardiovascular events.

Although the safety of bariatric surgery in patients with established cardiovascular disease has been demonstrated, little is known about the mid- to long-term survival of these patients after surgery. We conducted a retrospective cohort study of bariatric surgical patients (n = 349) compared with morbidly obese surgical controls (n = 903). Data were obtained on all patients 40 to 79 years of age, from 1996 to 2008, with a diagnosis code of morbid obesity, a primary surgical procedure of interest, and a cardiovascular event history.

Does bariatric surgery reduce the risk of major cardiovascular events? A retrospective cohort study of morbidly obese surgical patients.

Background: Morbid obesity is associated with the development of cardiovascular and cerebrovascular disease. Several studies have shown that bariatric surgery results in risk factor reduction; however, studies correlating bariatric surgery to the reduced rates of myocardial infarction, stroke, or death have been limited.

Methods: We conducted a large retrospective cohort study of bariatric (BAR) surgical patients (n = 4747) and morbidly obese orthopedic (n = 3066) and gastrointestinal (n = 1327) surgical controls.

Do patients with Down syndrome develop appendicitis?

Background/purpose: Given the number of individuals with Down syndrome (DS) and the high incidence of acute appendicitis (AA) in the general population, one would expect a certain number of patients with DS to develop AA. However, clinical experience suggests that AA is uncommon in patients with DS. This study was undertaken to determine whether the incidence of AA is significantly decreased in patients with DS.

Analysis of Centers for Medicaid and Medicare Services 'never events' in elderly patients undergoing bowel operations.

Since October 2008, the Centers for Medicare and Medicaid Services (CMS) has denied reimbursement for 10 hospital-acquired "never events," which were deemed reasonably preventable. This study compares the frequency and costs of CMS "never events" in patients undergoing bowel operations between ages 65 to 79 years and 80 years or older. Patients aged 65 years or older who underwent small or large bowel operations, from January 2008 to March 2009, were identified by a retrospective review of inpatient charts and the Greenville Hospital System electronic coding database.

Analysis of Centers for Medicaid and Medicare Services 'Never Events' in Elderly Patients Undergoing Bowel Operations, USA.

Since October 2008, the Centers for Medicare and Medicaid Services (CMS) has denied reimbursement for 10 hospital-acquired "never events," which were deemed reasonably preventable. This study compares the frequency and costs of CMS "never events" in patients undergoing bowel operations between ages 65 to 79 years and 80 years or older. Patients aged 65 years or older who underwent small or large bowel operations, from January 2008 to March 2009, were identified by a retrospective review of inpatient charts and the Greenville Hospital System electronic coding database.

Reference accuracy in peer-reviewed pediatric orthopaedic literature.

Background: Reference accuracy of articles published in the biomedical literature is determined by the presence of citation and quotation errors. A recent review demonstrated that the median citation error rate per biomedical journal was 39%, and the median quotation error rate per journal was 20%. Reference accuracy in pediatric orthopaedic articles has not been previously reported, to our knowledge.

Gluteal fascial advancement: an innovative, effective method for treating pilonidal disease.

The ideal elective surgical procedure for pilonidal disease is debated. Simple excision and closure is commonly performed but is associated with a high incidence of wound complications and recurrence. We developed a simple modification of primary closure, which involves the elevation, mobilization, and closure of the gluteal fascia.

The impact of isolated tibial disease on outcomes in the critical limb ischemic population.

Background: Most patients with critical limb ischemia (CLI) have multilevel infrainguinal peripheral arterial disease (M-PAD). One-third of CLI patients will have isolated tibial disease (ITD). The treatments for multilevel disease or ITD differ depending on whether open or endovascular procedures are used, but we questioned whether outcomes from these procedures differ.

The efficacy of the floor-reaction ankle-foot orthosis in children with cerebral palsy.

Background: The floor-reaction ankle-foot orthosis is commonly prescribed for children with cerebral palsy who walk with excessive ankle dorsiflexion and excessive knee flexion during the stance phase of gait. The purposes of this study were to evaluate the efficacy of this orthosis objectively and to identify clinical parameters that may compromise its function.

Methods: All children with cerebral palsy who had comprehensive gait analyses in both barefoot and braced walking conditions during a single visit to our Motion Analysis Laboratory between January 2001 and August 2007 were identified.

Evaluation of the diameter of the proximal descending thoracic aorta with age: implications for thoracic aortic stent grafting.

Background: Long-term anatomical changes of the thoracic aorta which may affect long-term outcome of blunt aortic injuries treated with endovascular stent grafts are unknown. The purpose of this study was to examine the natural history of thoracic aortic diameter with progressing age.

Methods: One thousand consecutive thoracic computed tomographic scans performed for nonthoracic aortic pathology on patients aged 15-99 (mean 59.

Surgical management of thumb deformity in children with hemiplegic-type cerebral palsy.

Background: Evidence-based clinical decision-making for the surgical management of thumb deformities in children with cerebral palsy is difficult, primarily because of a lack of consensus with respect to assessment of thumb alignment and function. We have used the Shriners Hospital Upper Extremity Evaluation, a validated assessment tool, to determine the outcome after thumb reconstruction surgery in these children. The goals of this study were to determine the relationship between static and dynamic assessments of the thumb before surgery, the outcomes with respect to static and dynamic alignments of the thumb after soft tissue and skeletal surgery, and the relationship between preoperative spontaneous functional use of the involved extremity (indicative of the magnitude of neurologic impairment) and the change in thumb dynamic alignment after surgery.

Comparison of interventional outcomes according to preoperative indication: a single center analysis of 2,240 limb revascularizations.

Background: Outcomes after lower extremity revascularization are usually reported according to the level of peripheral arterial disease (PAD, aortoiliac or infrainguinal) or the method of treatment (open or endovascular surgery). Outcomes stratified by indication, ie, claudication or critical limb ischemia (rest pain and tissue loss), have not been well studied. The purpose of this study was to compare postoperative outcomes according to the preoperative indications.

Dynamic pedobarography for children: use of the center of pressure progression.

Background: Although pedobarography has been widely used in quantitative clinical gait analysis for children, the collection, processing, analysis, and interpretation of the data vary widely. In most cases in children, foot dysfunction during gait is primarily a consequence of skeletal segmental malalignment, which can be characterized by the location and duration of the center of pressure progression (COPP) relative to the foot. This study determines the validity and reliability of a technique using the COPP and establishes a normative database for the COPP in children.

Simultaneous biplanar fluoroscopy for the surgical treatment of slipped capital femoral epiphysis.

Background: The current standard of care for treatment of slipped capital femoral epiphysis (SCFE) is in situ placement of a single, cannulated screw across the physis under direct fluoroscopic guidance. Previous studies have reported the theoretical advantages of shorter operative time and improved accuracy of screw placement when 2 fluoroscopy units are used simultaneously.

Methods: A retrospective review was performed to compare the use of 1 versus 2 C-arms in the surgical stabilization of SCFE.