National Healthcare Quality and Disparities Report
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Topics
- Ambulatory Care and Surgery (1)
- Arthritis (4)
- Back Health and Pain (1)
- Behavioral Health (1)
- Cancer (3)
- Cancer: Breast Cancer (2)
- Care Management (3)
- Centers for Education and Research on Therapeutics (CERTs) (1)
- Chronic Conditions (3)
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- Depression (1)
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- Education: Patient and Caregiver (2)
- Elderly (1)
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- Health Services Research (HSR) (1)
- Health Status (1)
- Hospital Readmissions (1)
- Medication (24)
- Medication: Safety (1)
- Neurological Disorders (1)
- Obesity (4)
- Obesity: Weight Management (1)
- Opioids (22)
- Orthopedics (13)
- Osteoporosis (1)
- Outcomes (10)
- (-) Pain (42)
- Patient-Centered Outcomes Research (11)
- Patient Experience (1)
- Practice Patterns (9)
- Quality Measures (1)
- Quality of Care (1)
- Quality of Life (3)
- Research Methodologies (1)
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- Risk (1)
- Stress (1)
- Substance Abuse (6)
- (-) Surgery (42)
- Transitions of Care (1)
- Women (1)
AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 42 Research Studies DisplayedAyers DC, Yousef M, Yang W
Age-related differences in pain, function, and quality of life following primary total knee arthroplasty: results from a FORCE-TJR (Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement) cohort.
The purpose of this prospective, multicenter cohort study was to evaluate the differences in pain, function, and quality of life (QoL) reported 1 year after total knee arthroplasty (TKA) across varying age groups. The researchers preoperatively assessed 11,602 unilateral primary TKA patients, and collected demographic data, comorbid conditions, and patient-reported outcome measures including the knee injury and osteoarthritis outcome score (KOOS), KOOS-12, KOOS Joint Replacement, and Short-Form health survey (12-item) and then collected again at 1-year postoperatively. The study found that prior to surgery, patients less than 55 years reported worse KOOS pain (39), function (50), and QoL (18) scores with poor mental health score (47) than other older patient groups. At 1 year after TKA, patients less than 55 years reported lower KOOS pain, function, and QoL scores when compared to patients 75 years or older. The differences in score changes among the age groups were statistically significant but clinically irrelevant. Further statistical analyses revealed that age was a significant predictor for pain, but not for function at 1 year where KOOS pain score was predicted to be higher in patients 75 years or older when compared to patients less than 55 years of age.
AHRQ-funded; HS018910.
Citation: Ayers DC, Yousef M, Yang W .
Age-related differences in pain, function, and quality of life following primary total knee arthroplasty: results from a FORCE-TJR (Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement) cohort.
J Arthroplasty 2023 Jul; 38(7 Suppl 2):S169-S76. doi: 10.1016/j.arth.2023.04.005..
Keywords: Orthopedics, Surgery, Quality of Life, Outcomes, Comparative Effectiveness, Evidence-Based Practice, Patient-Centered Outcomes Research, Pain
Ayers DC, Zheng H, Yang W
How back pain affects patient satisfaction after primary total knee arthroplasty.
This study looked at patient-reported outcomes (PROs) for patients with back pain (BP) who underwent total knee arthroscopy (TKA) surgery for pre- and postoperatively. This multicenter cohort study included 9,057 patients undergoing primary unilateral TKA who were enrolled in FORCE-TJ. Back pain (BP) intensity was assessed using the Oswestry back disability index (ODI) pain intensity questionnaire, with BP severity then classified into 4 categories. PROs were collected preoperatively and postoperatively after 1 year including the Knee injury and Osteoarthritis Outcome Score (KOOS) (total score, pain, Activities of Daily Living (ADL), and Quality of Life (QOL), Short-Form health survey 36-item (SF-36) Physical Component Score (PCS), and Mental Component Score (MCS)). At 1 year a total of 18.3% TKA patients were dissatisfied. At the time of surgery, a total of 4,765 patients (52.6%) reported back pain, divided into mild BP (24.9%), moderate (20.3%), and severe (7.2%). Severe back pain was significantly associated with patient dissatisfaction at 1 year after TKA. The predictive variables for dissatisfaction include age [odds ratio (OR) for younger patients <65 years versus older patients ≥65 years], educational level [OR for post high school versus less], smoking [OR for nonsmoker versus current smoker)], and Charlson comorbidity index [OR for CCI ≥2 versus 0]. The authors recommend surgeons consider a spine evaluation in patients who have severe BP prior to TKA.
AHRQ-funded; HS018910.
Citation: Ayers DC, Zheng H, Yang W .
How back pain affects patient satisfaction after primary total knee arthroplasty.
J Arthroplasty 2023 Jun; 38(6s):S103-s08. doi: 10.1016/j.arth.2023.03.072..
Keywords: Back Health and Pain, Pain, Pain, Patient Experience, Orthopedics, Surgery
Bongiovanni T, Gan S, Finlayson E
Prolonged use of newly prescribed gabapentin after surgery.
This study investigated postoperative prolonged gabapentin use in adults 65 years and older. The authors merged a 20% sample of Medicare Carrier, MedPAR, and Outpatient Files with Part D for 2013-2018. They defined new postoperative gabapentin as fills for 7 days before surgery until 7 days after discharge. Overall, 3% of all eligible patients (n = 17,970) had a new prescription for gabapentin postsurgery. Out of those, the mean age was 73 years old and 62% were female. The most common surgeries that gabapentin was prescribed for was total knee (45%) and total hip (21%) replacements. Prolonged use occurred in 22% of patients, with women, non-White, those with concurrent prolonged opioid use, and patients having undergone emergency surgery more likely to have prolonged use.
Citation: Bongiovanni T, Gan S, Finlayson E .
Prolonged use of newly prescribed gabapentin after surgery.
J Am Geriatr Soc 2022 Dec;70(12):3560-69. doi: 10.1111/jgs.18005..
Keywords: Medication, Surgery, Pain, Elderly, Practice Patterns
Howard R, Gunaseelan V, Brummett C
New persistent opioid use after inguinal hernia repair.
The purpose of this retrospective cross-sectional study was to characterize the risk factors and incidence of new persistent use of opioids after inguinal hernia repair. During the study period of 208-2016, 59,795 patients met the inclusion criteria. The study found that 1.5% of patients continued filling their opioids prescriptions at least 3 months after their surgery. The greatest risk factor for developing new persistent opioid use after surgery was filling an opioid prescription in the 30 days before surgery. Other risk factors for new persistent opioid use after surgery included having a major postoperative complication, receiving a larger opioid prescription, having more comorbidities, and having certain mental health disorders or pain disorders.
AHRQ-funded; HS025778.
Citation: Howard R, Gunaseelan V, Brummett C .
New persistent opioid use after inguinal hernia repair.
Ann Surg 2022 Nov 1;276(5):e577-e83. doi: 10.1097/sla.0000000000004560..
Keywords: Opioids, Surgery, Medication, Pain
Joseph JM, Gori D, Curtin C
Gaps in standardized postoperative pain management quality measures: a systematic review.
Poor pain control in patients can lead to chronic pain, chronic opiate use or addiction, and patient suffering, making postoperative pain an important clinical issue. The researchers state that it is unclear whether measures for managing pain after surgery exist, warranting the study goal of assessment of the availability of postoperative pain management quality measures, including National Quality Forum-endorsed measures. In November 2019, the researchers conducted a systematic literature review using the National Quality Forum Quality Positioning System, the Agency for Healthcare Research and Quality Indicators, and the Centers for Medicare and Medicaid Services Measures Inventory Tool databases, to identify quality measures for the period between March 11, 2015, and March 11, 2020. The review identified 19 pain management quality measures, 5 of which were endorsed by the National Quality Forum. Three of the non-endorsed measures were specific to postoperative pain, with none of the endorsed measures specific to post-operative pain. The study concluded that there is a need for published, endorsed, rigorous postoperative pain quality measures.
AHRQ-funded; HS024096; HS027434.
Citation: Joseph JM, Gori D, Curtin C .
Gaps in standardized postoperative pain management quality measures: a systematic review.
Surgery 2022 Feb;171(2):453-58. doi: 10.1016/j.surg.2021.08.004..
Keywords: Pain, Surgery, Quality Measures, Quality of Care, Practice Patterns
Pritchard KT, Baillargeon J, Raji Ma
Association of occupational and physical therapy with duration of prescription opioid use after hip or knee arthroplasty: a retrospective cohort study of Medicare enrollees.
The purpose of this study was to establish whether non-pharmacological interventions, such as occupational and physical therapy, were associated with a shorter duration of prescription opioid use after hip or knee arthroplasty. The investigators concluded that occupational and physical therapy with home health were associated with a shorter duration of prescription opioid use after hip and knee arthroplasty.
AHRQ-funded; HS026133.
Citation: Pritchard KT, Baillargeon J, Raji Ma .
Association of occupational and physical therapy with duration of prescription opioid use after hip or knee arthroplasty: a retrospective cohort study of Medicare enrollees.
Arch Phys Med Rehabil 2021 Jul;102(7):1257-66. doi: 10.1016/j.apmr.2021.01.086..
Keywords: Orthopedics, Surgery, Opioids, Pain, Practice Patterns
Agarwal AK, Lee D, Ali Z
Patient-reported opioid consumption and pain intensity after common orthopedic and urologic surgical procedures with use of an automated text messaging system.
This prospective study looked at the number of opioid tablets taken compared to the number prescribed after orthopedic and urologic surgery at a large urban academic health center in Pennsylvania from May to December 2019 with the use of an automated text messaging system. Of the 919 study participants, 80.7% (742) underwent orthopedic procedures and 19.2% underwent urologic procedures. Among those who underwent orthopedic procedures, 384 were women, 491 were White, and the median age was 48 years; with almost 70% outpatient procedures. Among those who underwent urologic procedures, 84.8% were men, 80.7% were White, and the median age was 56 years; 62% had an outpatient procedure. Orthopedic patients were prescribed an average of 20 tablets and urologic patients 7 tablets. The majority of patients (64.1%) used less than half of the amount prescribed, and 256 orthopedic and 77 urologic patients did not use any opioids. The findings suggest that clinicians can tailor prescriptions to limit excess quantities of prescribed opioids.
AHRQ-funded; HS026372.
Citation: Agarwal AK, Lee D, Ali Z .
Patient-reported opioid consumption and pain intensity after common orthopedic and urologic surgical procedures with use of an automated text messaging system.
JAMA Netw Open 2021 Mar;4(3):e213243. doi: 10.1001/jamanetworkopen.2021.3243..
Keywords: Opioids, Medication, Pain, Orthopedics, Surgery
Eyrich NW, Sloss KR, Howard RA
Opioid prescribing exceeds consumption following common surgical oncology procedures.
Researchers aimed to compare opioid prescribing to opioid consumption for common surgical oncology procedures. They found that the median quantity of opioid prescribed was significantly larger than consumed following breast biopsy, lumpectomy, and mastectomy or wide local excision. The majority of patients reported receiving education on taking opioids, but only 27% received instructions on proper disposal; 82% of prescriptions filled resulted in unused opioids, and only 11% of these patients safely disposed of them. They concluded that their study demonstrated that opioid prescribing exceeds consumption following common surgical oncology procedures, thus indicating the potential for reductions in prescribing.
AHRQ-funded; HS023313.
Citation: Eyrich NW, Sloss KR, Howard RA .
Opioid prescribing exceeds consumption following common surgical oncology procedures.
J Surg Oncol 2021 Jan;123(1):352-56. doi: 10.1002/jso.26272..
Keywords: Opioids, Medication, Surgery, Cancer: Breast Cancer, Cancer, Practice Patterns, Pain
Azad AD, Bozkurt S, Wheeler AJ
Acute pain after breast surgery and reconstruction: a two-institution study of surgical factors influencing short-term pain outcomes.
This study analyzed the relationship between differing breast cancer excisional procedures, reconstruction, and short-term pain outcomes. Women who underwent breast cancer surgery with and without reconstruction were included from two institutions: an academic hospital (AH) and a Veterans Health Administration (VHS) facility. Average pain scores at time of discharge and at 30-day follow-up were analyzed. The study included 1402 patients at AH and 1435 at VHA. Of those, 425 AH and 165 VHA patients underwent breast reconstruction. Pain scores were highest at discharge and improved over time. Younger age, preoperative opioid use, and longer length of stay were all associated with worse pain scores.
AHRQ-funded; HS024096.
Citation: Azad AD, Bozkurt S, Wheeler AJ .
Acute pain after breast surgery and reconstruction: a two-institution study of surgical factors influencing short-term pain outcomes.
J Surg Oncol 2020 Sep 15;122(4):623-31. doi: 10.1002/jso.26070..
Keywords: Pain, Cancer: Breast Cancer, Cancer, Surgery, Outcomes, Women
Hernandez-Boussard T, Graham LA, Carroll I
Perioperative opioid use and pain-related outcomes in the Veterans Health Administration.
This study characterized perioperative exposure to morphine and its association with postoperative pain and 30-day readmissions. Utilizing nationwide Veterans Healthcare Administration (VHA) data on four high-volume surgical procedures, the researchers found that patients receiving high perioperative oral morphine equivalents were more likely to return to care for pain-related problems.
AHRQ-funded; HS024096.
Citation: Hernandez-Boussard T, Graham LA, Carroll I .
Perioperative opioid use and pain-related outcomes in the Veterans Health Administration.
Am J Surg 2020 Jun;219(6):969-75. doi: 10.1016/j.amjsurg.2019.06.022..
Keywords: Opioids, Medication, Pain, Substance Abuse, Surgery, Hospital Readmissions
Weng Y, Tian L, Tedesco D
Trajectory analysis for postoperative pain using electronic health records: a nonparametric method with robust linear regression and K-medians cluster analysis.
Postoperative pain scores are widely monitored and collected in the electronic health record, yet current methods fail to fully leverage the data with fast implementation. This article describes a trajectory analysis for postoperative pain using electronic health records. A robust linear regression was fitted to describe the association between the log-scaled pain score and time from discharge after total knee replacement.
AHRQ-funded; HS024096.
Citation: Weng Y, Tian L, Tedesco D .
Trajectory analysis for postoperative pain using electronic health records: a nonparametric method with robust linear regression and K-medians cluster analysis.
Health Informatics J 2020 Jun;26(2):1404-18. doi: 10.1177/1460458219881339..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Pain, Surgery, Orthopedics, Research Methodologies, Health Services Research (HSR)
Newberry CI, Casazza GC, Pruitt LC
Prescription patterns and opioid usage in sinonasal surgery.
The goal of this study was to identify factors associated with variable opioid usage and to delineate optimal prescription patterns for sinonasal surgery. The researchers found that patients used 9.3% of their full prescription and only 2.6% required a refill. The amount used was not associated with complexity of endoscopic sinus surgery, type of opiate prescribed, gender, distance living from hospital, or current opioid usage before surgery. They concluded that opioids are overprescribed after sinonasal surgery and that the amount of postoperative opiate prescribed should be greatly reduced and may be based on the specific procedures performed.
AHRQ-funded; HS024638.
Citation: Newberry CI, Casazza GC, Pruitt LC .
Prescription patterns and opioid usage in sinonasal surgery.
Int Forum Allergy Rhinol 2020 Mar;10(3):381-87. doi: 10.1002/alr.22478..
Keywords: Opioids, Medication, Pain, Surgery, Respiratory Conditions, Healthcare Utilization, Practice Patterns, Substance Abuse
De Roo AC, Vu JV, Regenbogen SE
Statewide utilization of multimodal analgesia and length of stay after colectomy.
This study examined statewide utilization of multimodal analgesia after colectomy. Multimodal analgesia shortens length of stay and hastens recovery. The researchers conducted a statewide, 72-hospital collaborative quality initiative and evaluated postoperative analgesia regimens among adult elective colectomy patients between 2012 and 2015. One-third of patients received opioids alone, and 2.8% received one nonopioid pain medication alone. The researchers suggest that these numbers must be improved particularly with the current opioid crisis.
AHRQ-funded; HS000053.
Citation: De Roo AC, Vu JV, Regenbogen SE .
Statewide utilization of multimodal analgesia and length of stay after colectomy.
J Surg Res 2020 Mar;247:264-70. doi: 10.1016/j.jss.2019.10.014..
Keywords: Surgery, Opioids, Medication, Medication: Safety, Practice Patterns, Pain
Chin KK, Carroll I, Desai K
Integrating adjuvant analgesics into perioperative pain practice: results from an academic medical center.
This study evaluated adjuvant analgesic gabapentin use after total knee arthroplasty (TKA) surgery and its effects on opioid use, pain, and readmissions. This retrospective observational study included 4,046 TKA recipients from 2009 to 2017 using electronic health records from an academic tertiary care medical institute. Overall, there was an 8.72% annual increase in gabapentin use which was associated with a significant decrease in opioid consumption in modeled estimates. Patients receiving gabapentin had similar discharge and follow-up pain scores, and 30-day unplanned readmission rates compared with patients receiving no adjuvant analgesics.
AHRQ-funded; HS024096.
Citation: Chin KK, Carroll I, Desai K .
Integrating adjuvant analgesics into perioperative pain practice: results from an academic medical center.
Pain Med 2020 Jan;21(1):161-70. doi: 10.1093/pm/pnz053..
Keywords: Opioids, Medication, Pain, Surgery, Orthopedics
Singh JA, Lemay CA, Nobel L
Association of early postoperative pain trajectories with longer-term pain outcome after primary total knee arthroplasty.
Studies to date have not comprehensively examined pain experience after total knee arthroplasty (TKA). Discrete patterns of pain in this period might be associated with pain outcomes at 6 to 12 months after TKA. The purpose of this study was to examine patterns of individual post-TKA pain trajectories and to assess their independent associations with longer-term pain outcome after TKA.
AHRQ-funded; HS021110; HS018910.
Citation: Singh JA, Lemay CA, Nobel L .
Association of early postoperative pain trajectories with longer-term pain outcome after primary total knee arthroplasty.
JAMA Netw Open 2019 Nov;2(11):e1915105. doi: 10.1001/jamanetworkopen.2019.15105..
Keywords: Pain, Surgery, Orthopedics, Patient-Centered Outcomes Research, Outcomes
Lemay CA, Saag KG, Franklin PD
A qualitative study of the postoperative pain management educational needs of total joint replacement patients.
This study examined the challenges of pain management education for post-surgery of total joint replacement patients. The majority of patients have pain in the postoperative period and managing pain can be challenging. Nine orthopedic surgeons’ offices in 8 states recruited patients and 27 patients completed the interview. They were interviewed with open-ended questions on their experiences with pain after surgery, pain management, experiences with pain medicine, experience using non-medicine-related pain reduction methods, and suggestions for better pain management education. Challenges included lack of pain control and lack of information about prescribed opioid and nonopioid methods of managing pain.
AHRQ-funded; HS018910; HS021110.
Citation: Lemay CA, Saag KG, Franklin PD .
A qualitative study of the postoperative pain management educational needs of total joint replacement patients.
Pain Manag Nurs 2019 Aug;20(4):345-51. doi: 10.1016/j.pmn.2018.12.009..
Keywords: Pain, Orthopedics, Surgery, Education: Patient and Caregiver
Smith ME, Lee JS, Bonham A
Effect of new persistent opioid use on physiologic and psychologic outcomes following bariatric surgery.
In this study, the investigators sought to determine the relationship between new persistent opioid use and 1-year postoperative outcomes for patients undergoing bariatric surgery. The investigators concluded that new persistent opioid use is common following bariatric surgery and associated with significantly worse physiologic and psychologic outcomes. More effective screening and postoperative surveillance tools are needed to identify these patients, who likely require more aggressive counseling and treatment to maximize the benefits of bariatric surgery.
AHRQ-funded; HS024403.
Citation: Smith ME, Lee JS, Bonham A .
Effect of new persistent opioid use on physiologic and psychologic outcomes following bariatric surgery.
Surg Endosc 2019 Aug;33(8):2649-56. doi: 10.1007/s00464-018-6542-0..
Keywords: Opioids, Surgery, Medication, Obesity: Weight Management, Obesity, Obesity: Weight Management, Pain, Outcomes
Dy CJ, Peacock K, Olsen MA
Frequency and risk factors for prolonged opioid prescriptions after surgery for brachial plexus injury.
This study examined risk of prolonged opioid prescription use after surgery for brachial plexus injury (BPI). A cohort of BPI surgery patients was compared to a control group of non-BPI patients, matching for age, sex, and year. Pharmacy claims for prescriptions filled for opioids and neuropathic pain methods were examined 1 year before surgery to 180 days after surgery. The primary outcome studied was prolonged opioid prescription, which is defined as receiving a prescription 90 to 180 days after the surgery or randomly selected date of service for controls. Among BPI patients, a subgroup analysis was also performed on opioid-naïve patients between 30 days to 1 year before surgery. Among BPI surgery patients, 27.7% had prolonged opioid prescriptions, but only 10.8% of opioid-naïve patients had prolonged opioid prescriptions. The rate for controls was 0.11%. The rates of prolonged opioid prescriptions for BPI patients was higher than previous estimates among other surgical patients.
AHRQ-funded; HS019455.
Citation: Dy CJ, Peacock K, Olsen MA .
Frequency and risk factors for prolonged opioid prescriptions after surgery for brachial plexus injury.
J Hand Surg Am 2019 Aug;44(8):662-68.e1. doi: 10.1016/j.jhsa.2019.04.001..
Keywords: Opioids, Medication, Surgery, Pain, Practice Patterns, Risk, Chronic Conditions
Nguyen UDT, Perneger T, Franklin PD
Improvement in mental health following total hip arthroplasty: the role of pain and function.
This prospective study examined whether mental health improved in patients who had total hip arthroplasty (THA) due to improvement in pain and function 1 year post-surgery. Patients enrolled in a THA registry from 2010 to 2014 were included and the mental component score (MCS) was examined before and 1 year post-surgery. There was a significant improvement in mental health due to less pain and improved function.
AHRQ-funded; HS018910.
Citation: Nguyen UDT, Perneger T, Franklin PD .
Improvement in mental health following total hip arthroplasty: the role of pain and function.
BMC Musculoskelet Disord 2019 Jun 29;20(1):307. doi: 10.1186/s12891-019-2669-y..
Keywords: Health Status, Behavioral Health, Orthopedics, Outcomes, Pain, Patient-Centered Outcomes Research, Quality of Life, Surgery
Parthipan A, Banerjee I, Humphreys K
Predicting inadequate postoperative pain management in depressed patients: a machine learning approach.
Researchers employed a machine-learning approach to identify patients who were prescribed a combination of selective serotonin reuptake inhibitors (SSRIs) and prodrug opioids in order to examine the effect of this combination on postoperative pain control. They identified patients who received surgery over a 9-year period by using EHR data from an academic medical center, then developed and validated natural language processing (NLP) algorithms to extract depression-related information from both structured and unstructured data elements. The machine-learning algorithm accurately predicted the increase or decrease of the discharge, 3-week, and 8-week follow-up pain scores when compared to the pre-operative pain score; pre-operative pain, surgery type, and opioid tolerance were the strongest predictors of postoperative pain control. The researchers conclude that their study results provide the first direct clinical evidence that the known ability of SSRIs to inhibit prodrug opioid effectiveness is associated with worse pain control among depressed patients. They suggest that prescribers might choose direct acting opioids such as oxycodone or morphine for depressed patients on SSRIs instead of prodrug opioids.
AHRQ-funded; HS024096.
Citation: Parthipan A, Banerjee I, Humphreys K .
Predicting inadequate postoperative pain management in depressed patients: a machine learning approach.
PLoS One 2019 Feb 6;14(2):e0210575. doi: 10.1371/journal.pone.0210575..
Keywords: Care Management, Depression, Medication, Opioids, Pain, Surgery
Hilliard PE, Waljee J, Moser S
Prevalence of preoperative opioid use and characteristics associated with opioid use among patients presenting for surgery.
Researchers assessed the prevalence of preoperative opioid use and the characteristics of patients in a broadly representative surgical cohort. They found that patients undergoing lower extremity procedures were most likely to report preoperative opioid use, with 1 in 4 of all patients presenting for surgery reporting such use. They concluded that the data provided important insights into this population and would appear to help guide future preoperative optimization and perioperative opioid-weaning interventions.
AHRQ-funded; HS023313.
Citation: Hilliard PE, Waljee J, Moser S .
Prevalence of preoperative opioid use and characteristics associated with opioid use among patients presenting for surgery.
JAMA Surg 2018 Oct;153(10):929-37. doi: 10.1001/jamasurg.2018.2102..
Keywords: Opioids, Surgery, Pain, Medication, Healthcare Utilization, Orthopedics
Klueh MP, Hu HM, Howard RA
Transitions of care for postoperative opioid prescribing in previously opioid-naive patients in the USA: a retrospective review.
The purpose of this study was to identify specialties prescribing opioids to surgical patients who develop new persistent opioid use. Results showed that, among surgical patients who developed new persistent opioid use, surgeons provided the majority of opioid prescriptions during the first 3 months after surgery, but by 9 to 12 months after surgery, the majority of opioid prescriptions were provided by primary care physicians. Recommendations included enhanced care coordination between surgeons and primary care physicians to allow earlier identification of patients at risk for new persistent opioid use in order to prevent misuse and dependence.
AHRQ-funded; HS023313.
Citation: Klueh MP, Hu HM, Howard RA .
Transitions of care for postoperative opioid prescribing in previously opioid-naive patients in the USA: a retrospective review.
J Gen Intern Med 2018 Oct;33(10):1685-91. doi: 10.1007/s11606-018-4463-1..
Keywords: Transitions of Care, Opioids, Substance Abuse, Surgery, Pain, Medication, Patient-Centered Outcomes Research
Sekhri S, Arora NS, Cottrell H
Probability of opioid prescription refilling after surgery: does initial prescription dose matter?
In this study, the investigators 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. The investigators concluded that the probability of refilling prescription opioids after surgery was not correlated with initial prescription strength, suggesting surgeons could prescribe smaller prescriptions without influencing refill requests.
AHRQ-funded; HS023313.
Citation: Sekhri S, Arora NS, Cottrell H .
Probability of opioid prescription refilling after surgery: does initial prescription dose matter?
Ann Surg 2018 Aug;268(2):271-76. doi: 10.1097/sla.0000000000002308..
Keywords: Medication, Opioids, Pain, Practice Patterns, Substance Abuse, Surgery
Skolasky RL, Scherer EA, Wegener ST
Does reduction in sciatica symptoms precede improvement in disability and physical health among those treated surgically for intervertebral disc herniation? Analysis of temporal patterns in data from the Spine Patient Outcomes Research Trial.
This study aimed to evaluate pathways for improvements in quality of life during the first year after surgery for IDH by studying temporal relationships between sciatica symptoms, pain-related disability, and physical health. Investigators found that three months after surgery, patients reported reduced sciatica and pain-related disability. Early reduction in pain-related disability is important because path analysis indicated that disability at 3 months was predictive of sciatica and physical health at 1 year.
AHRQ-funded; HS017990; HS016106.
Citation: Skolasky RL, Scherer EA, Wegener ST .
Does reduction in sciatica symptoms precede improvement in disability and physical health among those treated surgically for intervertebral disc herniation? Analysis of temporal patterns in data from the Spine Patient Outcomes Research Trial.
Spine J 2018 Aug;18(8):1318-24. doi: 10.1016/j.spinee.2017.11.016.
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Keywords: Disabilities, Outcomes, Pain, Patient-Centered Outcomes Research, Quality of Life, Surgery
Desai K, Carroll I, Asch SM
Utilization and effectiveness of multimodal discharge analgesia for postoperative pain management.
In this study, the investigators sought to assess the association between discharge multimodal analgesia and postoperative pain outcomes in two diverse health care settings. They evaluated patients undergoing four common surgeries associated with high pain in electronic health records from an academic hospital (AH) and Veterans Health Administration (VHA). The investigators found that a majority of surgical patients received a multimodal pain approach at discharge yet many received only opioids. Multimodal regimen at discharge was associated with better follow-up pain and all-cause readmissions compared to the opioid-only regimen.
AHRQ-funded; HS024096.
Citation: Desai K, Carroll I, Asch SM .
Utilization and effectiveness of multimodal discharge analgesia for postoperative pain management.
J Surg Res 2018 Aug;228:160-69. doi: 10.1016/j.jss.2018.03.029..
Keywords: Care Management, Medication, Opioids, Pain, Surgery