An examination of gastrointestinal absorption using the acetaminophen absorption test in critically ill patients with COVID-19: A retrospective cohort study.

OBJECTIVE: Gastrointestinal (GI) dysfunction is prevalent in critically ill patients with coronavirus disease 2019 (COVID-19). The acetaminophen absorption test (AAT) has been previously described as a direct method for assessment of GI function. Our study determines whether the AAT can be used to assess GI function in critically ill COVID-19 patients, compared with traditional measures of GI function. DESIGN: Retrospective observational study of critically ill patients with COVID-19. SETTING: Three intensive care units at a tertiary care academic medical center. PATIENTS: Twenty critically ill patients with COVID-19. INTERVENTIONS: The results of AAT and traditional measures for assessing GI function were collected and compared. MEASUREMENTS AND MAIN RESULTS: Among the study cohort, 55% (11 of 20) of patients had evidence of malabsorption by AAT. Interestingly, all patients with evidence of malabsorption by AAT had clinical evidence of bowel function, as indicated by stool output and low gastric residuals during the prior 24 h. When comparing patients with a detectable acetaminophen level (positive AAT) with those who had undetectable acetaminophen levels (negative AAT), radiologic evidence of ileus was less frequent (20 vs 88%; P = .03), tolerated tube-feed rates were higher (40 vs 10 ml/h; P =.01), and there was a trend toward lower gastric residual volumes (45 vs 830 ml; P =.11). CONCLUSION: Malabsorption can occur in critically ill patients with COVID-19 despite commonly used clinical indicators of tube-feeding tolerance. The AAT provides a simple, rapid, and cost-effective mechanism by which enteral function can be efficiently assessed in COVID-19 patients.

Opioid Fills for Lumbar Facet Radiofrequency Ablation Associated with New Persistent Opioid Use.

BACKGROUND: Zygapophyseal (facet) joint interventions are the second most common interventional procedure in pain medicine. Opioid exposure after surgery is a significant risk factor for chronic opioid use. The aim of this study was to determine the incidence of new persistent use of opioids after lumbar facet radiofrequency ablation and to assess the effect of postprocedural opioid prescribing on the development of new persistent opioid use. METHODS: The authors conducted a retrospective cohort study using claims from the Clinformatics Data Mart Database (OptumInsight, USA) to identify opioid-naïve patients between 18 and 64 yr old who had lumbar radiofrequency ablation. Patients who had either subsequent radiofrequency ablation 15 to 180 days or subsequent surgery within 180 days after the primary procedure were excluded from the analysis. The primary outcome was new persistent opioid use, defined as opioid prescription fulfillment within the 8 to 90 and 91 to 180 day periods after radiofrequency ablation. The authors then assessed patient-level risk factors for new persistent opioid use. RESULTS: A total of 2,887 patients met the inclusion criteria. Of those patients, 2,277 (78.9%) had radiofrequency ablation without a perioperative opioid fill, and 610 (21.1%) patients had the procedure with a perioperative opioid fill. The unadjusted rate of new persistent opioid use was 5.6% (34 patients) in the group with a perioperative opioid fill versus 2.8% (63 patients) for those without an opioid fill. Periprocedural opioid prescription fill was independently associated with increased odds of new persistent use (adjusted odds ratio, 2.35; 95% CI, 1.51 to 3.66; P < 0.001). CONCLUSIONS: Periprocedural opioid use after lumbar radiofrequency ablation was associated with new persistent use in previously opioid-naïve patients, suggesting that new exposure to opioids is an independent risk factor for persistent use in patients having radiofrequency ablation for chronic back pain. Opioid prescribing after radiofrequency ablation should be reevaluated and likely discontinued in this population.

Body Mass Index Class Is Independently Associated With Health-Related Quality of Life After Primary Total Hip Arthroplasty: An Institutional Registry-Based Study.

BACKGROUND: The purpose of this study was to compare the health-related quality of life (HRQoL) of patients across World Health Organization (WHO) body mass index (BMI) classes before and after total hip arthroplasty (THA). METHODS: Patients with end-stage hip osteoarthritis who received elective primary unilateral THA were identified through an institutional registry and categorized based on the World Health Organization BMI classification. Age, sex, laterality, year of surgery, and Charlson-Deyo comorbidity index were recorded. The primary outcome was the EQ-5D-3L index and visual analog scale (EQ-VAS) scores at 2 years postoperatively. Inferential statistics and regression analyses were performed to determine associations between BMI classes and HRQoL. RESULTS: EQ-5D-3L scores at baseline and at 2 years were statistically different across BMI classes, with higher EQ-VAS and index scores in patients with lower BMI. There was no difference observed for the 2-year change in EQ-VAS scores, but there was a statistically greater increase in index scores for more obese patients. In the regression analyses, there were statistically significant negative effect estimates for EQ-VAS and index scores associated with increasing BMI class. CONCLUSION: BMI class is independently associated with lower HRQoL scores 2 years after primary THA. While absolute scores in obese patients were lower than in nonobese patients, obese patients enjoyed more positive changes in EQ-5D index scores after THA. These results may provide the most detailed information on how BMI influences HRQoL before and after THA, and they are relevant to future economic decision analyses on the topic.

Patients Have Strong Preferences and Perceptions for Biceps Tenotomy Versus Tenodesis.

PURPOSE: To evaluate what factors are important in the patients' preference and their perception of a successful surgical outcome. METHODS: A biceps-specific questionnaire was developed using a series of questions assessing current symptoms, previous knowledge of biceps tendon surgery, surgical outcome priorities, and patient demographics and administered to 100 patients with proximal biceps pathology after approval by the Institutional Review Board. The patients were asked which surgery they would prefer. A set of χ2 tests were used to test the association between categorical variables. All tests were 2-sided and considered significant at P < .05. RESULTS: A total of 100 patients enrolled in the study, with 49 female and 51 male patients at an average age of 49 years (range, 19 to 79 years). Of the 100 patients, 64 (64%) chose to have biceps tenodesis. Factors predictive of choosing a biceps tenodesis included female sex, and concern of cosmetic deformity and residual postoperative pain with a tenotomy (P < .05). Factors predictive of choosing a tenotomy included male sex, high level of current biciptal groove pain, and concerns regarding the use of additional hardware and longer recovery with a tenodesis (P < .05). Age, body mass index, occupation, income level, and concerns regarding postoperative strength and muscle cramping were not found to have a significant predictive effect toward either procedure. CONCLUSIONS: Patient age should not be used as the sole criterion when deciding between biceps tenotomy and tenodesis. Our results can be consolidated to 5 predictive, reliable questions that will assist orthopaedic surgeons in making individualized patient-specific decisions regarding proximal biceps tendon surgery by emphasizing what factors are most important to patients for a successful surgical outcome.