The opioid epidemic in the United States continues to lead to a substantial number of preventable deaths and disability. The development of opioid dependence has been strongly linked to previous ...opioid exposure. Trauma patients are at particular risk since opioids are frequently required to control pain after injury. The purpose to this study was to examine the prevalence of opioid use before and after injury and to identify risk factors for persistent long-term opioid use after trauma.
Records for all patients admitted to a Level 1 trauma center over a 1-year period were analyzed. Demographics, injury characteristics, and hospital course were recorded. A multistate Prescription Drug Monitoring Program database was queried to obtain records of all controlled substances prescribed from 6 months before the date of injury to 12 months after hospital discharge. Patients still receiving narcotics at 1 year were defined as persistent long-term users and were compared against those who were not.
A total of 2,992 patients were analyzed. Of all patients, 20.4% had filled a narcotic prescription within the 6 months before injury, 53.5% received opioids at hospital discharge, and 12.5% had persistent long-term use after trauma with the majority demonstrating preinjury use. Univariate risk factors for long-term use included female sex, longer length of stay, higher Injury Severity Score, anxiety, depression, orthopedic surgeries, spine injuries, multiple surgical locations, discharge to acute inpatient rehab, and preinjury opioid use. On multivariate analysis, the only significant predictors of persistent long-term prescription opioid use were preinjury use and a much smaller effect associated with use at discharge.
During a sustained opioid epidemic, concerns and caution are warranted in the use of prescription narcotics for trauma patients. However, persistent long-term opioid use among opioid-naive patients is rare and difficult to predict after trauma.
Prognostic and Epidemiological; Level III.
Abstract Background Patients with pulmonary hypertension (PHTN) are at increased risk for worse outcomes post–liver transplant (LT). This study evaluated LT outcomes and complications for a large ...number of LT patients with mild to moderate PHTN. Materials and methods This is a retrospective review of data from 2001 to 2011. All cases of PHTN were diagnosed with catheterization (mean pulmonary artery pressure) and categorized according to standard criteria: low-mild, 25–29 mm Hg; high-mild, 30–34 mm Hg; moderate, 35–44 mm Hg; and severe, ≥45 mm Hg. Our center protocol excludes most patients with known moderate and severe PHTN from LT. Outcomes included early liver function, ventilator time, hospital length of stay, and graft and patient survival. Results We reviewed the cardiac and pulmonary records for 1263 patients. There were 102 patients with confirmed PHTN (8%): 63 low-mild, 30 high-mild, and 9 moderate. Patients with PHTN were older ( P < 0.001). Patients with PHTN were more likely to have prolonged post-transplant ventilator weaning (40% versus 26% >48 h post-transplant; P < 0.01) and a longer length of hospital stay (12 versus 10 d; P = 0.08). The PHTN had a lower 1-y graft survival (79% versus 87%; P = 0.05). There were no statistical differences in early graft function or in long-term patient survival. Conclusions These results suggest that PHTN patients require longer post–liver transplant ventilation and length of hospital stay, but have similar early graft function and long-term survival. The risk of PHTN in these patients increases with increasing age.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Postoperative pancreatic fistula (POPF) remains the most common complication after distal pancreatectomy. The International Study Group on Pancreatic Surgery definition of POPF is used worldwide. ...Recently, an update of the definition was published. The aim of this study was to determine the clinical impact of the update.
An international retrospective validation study, including patients who underwent DP (2005 –2016) in 5 centers was performed. Distribution of complications amongst POPF grades were compared for the old and updated definition.
In total, 1089 patients were included. The incidence of POPF decreased with the updated definition from 47% to 24% (P < 0.01), largely because a downgrade of grade A and grade B into biochemical leak. Comparable morbidity was seen in the old and updated ‘no POPF group’ (Clavien –Dindo 3 5% vs. 6% P = 0.320 and hospital stay (7 vs. 7 days P = 0.301). The change in definition of POPF grade B resulted in more Clavien –Dindo 3 (38% vs. 51%) P < 0.01) and longer hospital stay (9 9 –13 vs. 9 days 7 –15 P < 0.01) in the updated `grade B group’.
Applying the updated POPF definition showed improved discrimination between grades and should therefore be used to report POPF after DP.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
<p data-select-like-a-boss="1">Objective: The aim of this study was to compare oncological outcomes after minimally invasive distal pancreatectomy (MIDP) with open distal pancreatectomy (ODP) in ...patients with pancreatic ductal adenocarcinoma (PDAC).
Background: Cohort studies have suggested superior short-term outcomes of MIDP vs. ODP. Recent international surveys, however, revealed that surgeons have concerns about the oncological outcomes of MIDP for PDAC.
Methods: This is a pan-European propensity score matched study including patients who underwent MIDP (laparoscopic or robot-assisted) or ODP for PDAC between January 1, 2007 and July 1, 2015. MIDP patients were matched to ODP patients in a 1:1 ratio. Main outcomes were radical (R0) resection, lymph node retrieval, and survival.
Results: In total, 1212 patients were included from 34 centers in 11 countries. Of 356 (29%) MIDP patients, 340 could be matched. After matching, the MIDP conversion rate was 19% (n = 62). Median blood loss 200 mL (60–400) vs 300 mL (150–500), P = 0.001 and hospital stay 8 (6–12) vs 9 (7–14) days, P < 0.001 were lower after MIDP. Clavien-Dindo grade ≥3 complications (18% vs 21%, P = 0.431) and 90-day mortality (2% vs 3%, P > 0.99) were comparable for MIDP and ODP, respectively. R0 resection rate was higher (67% vs 58%, P = 0.019), whereas Gerota's fascia resection (31% vs 60%, P < 0.001) and lymph node retrieval 14 (8–22) vs 22 (14–31), P < 0.001 were lower after MIDP. Median overall survival was 28 95% confidence interval (CI), 22–34 versus 31 (95% CI, 26–36) months ( P = 0.929).
Conclusions: Comparable survival was seen after MIDP and ODP for PDAC, but the opposing differences in R0 resection rate, resection of Gerota's fascia, and lymph node retrieval strengthen the need for a randomized trial to confirm the oncological safety of MIDP.
OBJECTIVE:The aim of this study was to compare oncological outcomes after minimally invasive distal pancreatectomy (MIDP) with open distal pancreatectomy (ODP) in patients with pancreatic ductal ...adenocarcinoma (PDAC).
BACKGROUND:Cohort studies have suggested superior short-term outcomes of MIDP vs. ODP. Recent international surveys, however, revealed that surgeons have concerns about the oncological outcomes of MIDP for PDAC.
METHODS:This is a pan-European propensity score matched study including patients who underwent MIDP (laparoscopic or robot-assisted) or ODP for PDAC between January 1, 2007 and July 1, 2015. MIDP patients were matched to ODP patients in a 1:1 ratio. Main outcomes were radical (R0) resection, lymph node retrieval, and survival.
RESULTS:In total, 1212 patients were included from 34 centers in 11 countries. Of 356 (29%) MIDP patients, 340 could be matched. After matching, the MIDP conversion rate was 19% (n = 62). Median blood loss 200 mL (60–400) vs 300 mL (150–500), P = 0.001 and hospital stay 8 (6–12) vs 9 (7–14) days, P < 0.001 were lower after MIDP. Clavien-Dindo grade ≥3 complications (18% vs 21%, P = 0.431) and 90-day mortality (2% vs 3%, P > 0.99) were comparable for MIDP and ODP, respectively. R0 resection rate was higher (67% vs 58%, P = 0.019), whereas Gerotaʼs fascia resection (31% vs 60%, P < 0.001) and lymph node retrieval 14 (8–22) vs 22 (14–31), P < 0.001 were lower after MIDP. Median overall survival was 28 95% confidence interval (CI), 22–34 versus 31 (95% CI, 26–36) months (P = 0.929).
CONCLUSIONS:Comparable survival was seen after MIDP and ODP for PDAC, but the opposing differences in R0 resection rate, resection of Gerotaʼs fascia, and lymph node retrieval strengthen the need for a randomized trial to confirm the oncological safety of MIDP.
Abstract Background Management of organ donors in the intensive care unit is an emerging subject in critical care and transplantation. This study evaluates organ yield outcomes for a large number of ...patients managed by the Indiana Organ Procurement Organization. Materials and methods This is a retrospective review of intensive care unit records from 2008–2012. Donor demographic information and seven donor management parameters (DMP) were recorded at admission, consent, 12 h after consent, and before procurement. Three study groups were created: donors meeting 0–3, 4, or 5–7 DMP. Active donor Organ Procurement Organization management began at consent; so, data analysis focuses on the 12-h postconsent time point. Outcomes included organs transplanted per donor (OTPD) and transplantation of individual solid organs. Results Complete records for 499 patients were reviewed. Organ yield was 1415 organs of 3992 possible (35%). At 12 h, donors meeting more DMP had more OTPD: 2.2 (0–3) versus 3.0 (4) versus 3.5 (5–7) ( P < 0.01). Aggregate DMP met was significantly associated with transplantation of every organ except intestine. Oxygen tension, vasopressor use, and central venous pressure were the most frequent independent predictors of organ usage. There were significantly more organs transplanted for donors meeting all three of these parameters (4.5 versus 2.7, P < 0.01). Conclusions Initial DMP met does not appear to be a significant prognostic factor for OTPD. Aggregate DMP is associated with transplantation rates for most organs, with analysis of individual parameters suggesting that appropriate management of oxygenation, volume status, and vasopressor use could lead to more organs procured per donor.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Objectives
Previous research suggests that cognitive performance worsens during manic and depressed states in bipolar disorder (BD). However, studies have often relied upon between‐subject, ...cross‐sectional analyses and smaller sample sizes. The current study examined the relationship between mood symptoms and cognition in a within‐subject, longitudinal study with a large sample.
Methods
Seven hundred and seventy‐three individuals with BD completed a neuropsychological battery and mood assessments at baseline and 1‐year follow‐up. The battery captured eight domains of cognition: fine motor dexterity, visual memory, auditory memory, emotion processing, and four aspects of executive functioning: verbal fluency and processing speed; conceptual reasoning and set shifting; processing speed with influence resolution; and inhibitory control. Structural equation modeling was conducted to examine the cross‐sectional and longitudinal relationships between depressive symptoms, manic symptoms, and cognitive performance. Age and education were included as covariates. Eight models were run with the respective cognitive domains.
Results
Baseline mood positively predicted 1‐year mood, and baseline cognition positively predicted 1‐year cognition. Mood and cognition were generally not related for the eight cognitive domains. Baseline mania was predictive in one of eight baseline domains (conceptual reasoning and set shifting); baseline cognition predicted 1‐year symptoms (inhibitory control—depression symptoms, visual memory—manic symptoms).
Conclusions
In a large community sample of patients with bipolar spectrum disorder, cognitive performance appears to be largely unrelated to depressive and manic symptoms, suggesting that cognitive dysfunction is stable in BD and is not dependent on mood state in BD. Future work could examine how treatment affects relationship between cognition and mood.
Significant Outcomes
Cognitive dysfunction appears to be largely independent of mood symptoms in bipolar disorder.
Limitations
The sample was generally highly educated (M = 15.22), the majority of the subsample with elevated manic symptoms generally presented with concurrent depressive elevated symptoms, and the study did not stratify recruitment based on mood state.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
Using a dataset of 274 male Thoroughbred racehorses in the United States, we study the effect of age on racing performance. Beyer speed figures, which are uniform measures of racing performance ...across distance and racing surface, are utilized in this study. A system of equations is estimated to determine quadratic improvement and decline in racing performance. We find that a typical horse's peak racing age is 4.45 years. The rate of improvement from age 2 to 4 1/2 is greater than the rate of decline after age 4 1/2. A typical horse will improve by 10 (horse) lengths in sprints (less than 1 mile) and 15 lengths in routes (one mile or greater) from age 2 to 4 1/2. Over the next five years the typical decline is 6 lengths for sprints and 9 1/2 lengths for routes.
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