Trends in Gender-affirming Surgery in Insured Patients in the United States.

Background: An estimated 0.6% of the U.S.

Opioid Prescribing After Curative-Intent Surgery: A Qualitative Study Using the Theoretical Domains Framework.

Background: Excessive opioid prescribing is common after curative-intent surgery, but little is known about what factors influence prescribing behaviors among surgeons. To identify targets for intervention, we performed a qualitative study of opioid prescribing after curative-intent surgery using the Theoretical Domains Framework, a well-established implementation science method for identifying factors influencing healthcare provider behavior.

Methods: Prior to data collection, we constructed a semi-structured interview guide to explore decision making for opioid prescribing.

Perioperative Antibiotics for Clean Hand Surgery: A National Study.

Purpose: Given that surgical site infections remain a common performance metric in assessing the quality of health care, we hypothesized that prophylactic antibiotics are overutilized in soft tissue hand surgery when antimicrobials are not indicated.

Methods: We studied insurance claims from the Truven MarketScan Databases to identify patients who underwent 1 of 5 outpatient hand surgery procedures: open or endoscopic carpal tunnel release, trigger finger release, de Quervain release, and wrist ganglion excision between 2009 and 2015 (n = 305,946). Hospital payment claims for preoperative intravenous antibiotics and prescriptions filled for postoperative oral antibiotics were analyzed.

Gender Views and Relationships in Families of Children With Craniofacial Differences.

Objective: Gender values and beliefs are known to influence family functioning. The aim of the current study was to describe the association between views about gender and family functioning within families with a child with a craniofacial difference (CFD).

Design: Participants included 74 dyads composed of children (8-18 years old) with CFD (n = 36 female), including cleft lip/palate, and a parent (n = 56 female).

Antibiotic Prophylaxis after Immediate Breast Reconstruction: The Reality of Its Efficacy.

Background: Numerous techniques are used to prevent infection after immediate implant-based breast reconstruction. Postoperative antibiotic prophylaxis is commonly prescribed to decrease the risk of reconstructive failure, despite conflicting evidence regarding its effectiveness. The authors studied whether postoperative antibiotic prophylaxis decreases the risk of infection-related explantation in the setting of immediate prosthesis-based breast reconstruction.

Defining an Optimal Adherence Threshold for Patients Taking Subcutaneous Anti-TNFs for Inflammatory Bowel Diseases.

Objectives: In patients with inflammatory bowel disease (IBD) using biological therapy, non-adherence leads to anti-drug antibody formation and reduced effectiveness. Little is known about the optimal level of adherence in IBD patients on biologic therapy. We aimed to identify the association between adherence and disease flare and determine an optimal level of adherence.

Reduction in Opioid Prescribing Through Evidence-Based Prescribing Guidelines.

This interrupted time series analysis found significant changes in multiple dimensions of pain medication usage after the implementation of postoperative opioid prescription guidelines in a single hospital.

Persistent Opioid Use Among Pediatric Patients After Surgery.

Background: Despite efforts to reduce nonmedical opioid misuse, little is known about the development of persistent opioid use after surgery among adolescents and young adults. We hypothesized that there is an increased incidence of prolonged opioid refills among adolescents and young adults who received prescription opioids after surgery compared with nonsurgical patients.

Methods: We performed a retrospective cohort study by using commercial claims from the Truven Health Marketscan research databases from January 1, 2010, to December 31, 2014.

Prescription Opioid Use among Opioid-Naive Women Undergoing Immediate Breast Reconstruction.

Background: Cancer patients may be particularly vulnerable to the deleterious effects of prolonged opioid use. The authors explored the factors that influence postoperative opioid prescription fills among women following postmastectomy reconstruction.

Methods: Using the Truven Health MarketScan Research Databases, the authors identified a cohort of 4113 opioid-naive patients undergoing mastectomy and immediate breast reconstruction between January of 2010 and August of 2014.

New Persistent Opioid Use Among Patients With Cancer After Curative-Intent Surgery.

Purpose The current epidemic of prescription opioid misuse has increased scrutiny of postoperative opioid prescribing. Some 6% to 8% of opioid-naïve patients undergoing noncancer procedures develop new persistent opioid use; however, it is unknown if a similar risk applies to patients with cancer. We sought to define the risk of new persistent opioid use after curative-intent surgery, identify risk factors, and describe changes in daily opioid dose over time after surgery.

Speech Perceptions and Health-Related Quality of Life Among Children With Cleft Lip and Palate.

Background: The association between perception of speech and health-related quality of life (HRQOL) among patients with cleft palate is not well understood. The purpose of this study was to determine: the agreement between patient and parent perception of speech, the correlation between patient/parent speech perception and objective analysis by a speech-language pathologist (SLP), and the relationship between objective speech analysis and HRQOL among children with cleft lip with or without palate (CLCP).

Methods: The authors surveyed 108 CLCP patients who received treatment at a large tertiary medical center from 2013 to 2014.

Improved Rates of Immediate Breast Reconstruction at Safety Net Hospitals.

Background: Substantial federal resources have been directed toward ensuring the delivery of high-quality care at safety net hospitals. Although disparities in receipt of breast reconstruction persist at the patient level, the extent to which hospital factors contribute to these differences remains unclear. The rates of immediate breast reconstruction across safety net and non-safety net hospitals were investigated.

Probability of Opioid Prescription Refilling After Surgery: Does Initial Prescription Dose Matter?

Objective: We sought to determine the correlation between the probability of postoperative opioid prescription refills and the amount of opioid prescribed, hypothesizing that a greater initial prescription yields a lower probability of refill.

Background: Although current guidelines regarding opioid prescribing largely address chronic opioid use, little is known regarding best practices and postoperative care.

Methods: We analyzed Optum Insight claims data from 2013 to 2014 for opioid-naïve patients aged 18 to 64 years who underwent major or minor surgical procedures (N = 26,520).

Postoperative Patient- and Parent-Reported Outcomes for Children with Congenital Hand Differences: A Systematic Review.

Background: Patient- and parent-reported outcomes are increasingly considered as measures of treatment effectiveness for congenital conditions. The authors' specific aim was to review the use of patient- and parent-reported outcomes of quality of life, activities of daily living, perception of hand appearance, and satisfaction after reconstruction for congenital hand differences.

Methods: The authors reviewed articles addressing congenital hand differences from PubMed, MEDLINE, and EMBASE published between January of 1966 and October of 2016.

Comparing Health Care Resource Use between Implant and Autologous Reconstruction of the Irradiated Breast: A National Claims-Based Assessment.

Background: In the debate on reconstruction of the irradiated breast, there is little information on associated health care resource use. Nationwide data were used to examine health care resource use associated with implant and autologous reconstruction. It was hypothesized that failure rates would contribute the most to higher average cumulative cost with either reconstruction method.

Postoperative Opioid Prescribing and the Pain Scores on Hospital Consumer Assessment of Healthcare Providers and Systems Survey.

This study uses insurance claims and HCAHPS data to investigate correlations between measures of pain and patient satisfaction after hospital discharge and postoperative opioid prescriptions.

New Persistent Opioid Use After Minor and Major Surgical Procedures in US Adults.

Importance: Despite increased focus on reducing opioid prescribing for long-term pain, little is known regarding the incidence and risk factors for persistent opioid use after surgery.

Objective: To determine the incidence of new persistent opioid use after minor and major surgical procedures.

Design, Setting, And Participants: Using a nationwide insurance claims data set from 2013 to 2014, we identified US adults aged 18 to 64 years without opioid use in the year prior to surgery (ie, no opioid prescription fulfillments from 12 months to 1 month prior to the procedure).

A National Study of the Impact of Delayed Flap Timing for Treatment of Patients with Deep Sternal Wound Infection.

Background: This study aimed to evaluate the impact of delayed flap closure on mortality and resource use for treatment of deep sternal wound infection.

Methods: The authors analyzed the Truven MarketScan Databases from 2009 to 2013 to identify adult patients who developed deep sternal wound infection after open cardiac surgery and who underwent flap closure for treatment. A multivariable logistic regression model was created to evaluate the relationship between mortality and flap timing.

Effect of Preoperative Opioid Exposure on Healthcare Utilization and Expenditures Following Elective Abdominal Surgery.

Objective: To examine the extent to which preoperative opioid use is correlated with healthcare utilization and costs following elective surgical procedures.

Summary Background Data: Morbidity and mortality associated with prescription opioid use is escalating in the United States. The extent to which chronic opioid use influences postoperative outcomes following elective surgery is not well understood.

Reconstruction of the Irradiated Breast: A National Claims-Based Assessment of Postoperative Morbidity.

Background: Implant-based reconstruction rates have risen among irradiation-treated breast cancer patients in the United States. This study aims to assess the morbidity associated with various breast reconstruction techniques in irradiated patients.

Methods: From the MarketScan Commercial Claims and Encounters database, the authors selected breast cancer patients who had undergone mastectomy, irradiation, and breast reconstruction from 2009 to 2012.

The Impact of Deep Sternal Wound Infection on Mortality and Resource Utilization: A Population-based Study.

Background: Recent national infection control efforts have been directed at reducing postsurgical infection rates, related morbidity, and cost. We sought to evaluate population-level rates of deep sternal wound infection (DSWI) after cardiac surgery, associated mortality, and resource use compared to patients undergoing cardiac surgery without postoperative DSWI relative to historical trends.

Methods: We analyzed the MarketScan Commercial Claims Databases from 2009 to 2013 to identify adult patients who developed DSWI after open cardiac surgery.