Long-term postoperative opioid use in orthopaedic patients.

BACKGROUND: The prevalence of long-term opioid use after orthopaedic surgery varies from 1.4% to 24% and has mostly been studied with prescription data, making it difficult to estimate the size and impact of the problem. This study aims to assess the prevalence and predictors of long-term postoperative opioid use in a high volume and tertiary orthopaedic centre by using online patient reported measures. METHODS: This Dutch prospective cohort study was conducted among adult patients who underwent any type of orthopaedic surgery from June to August 2021. Six months after surgery patients were invited to complete an online survey on current opioid use and patients' willingness to taper opioids. The demographics, clinical factors and preoperative opioid use were extracted from the patient file. RESULTS: In total, 607 patients (mean age 61.2 years, 63.4% female) completed the survey. Seventy-six patients (12.5%) used opioids 6 months after surgery of which 20 (3.3%) did not use opioids before surgery. The median (Q1-Q3) postoperative daily dose after 6 months was 29.9 mg (10.0-76.1) morphine equivalents. Most of them (88.2%) wanted to taper opioids. Affected body region (OR's: 6.84-12.75) and pre-operative opioid use (OR = 35.33) were significant predictors of long-term opioid use. CONCLUSION: The prevalence of long-term postoperative opioid use was 12.5%; one in thirty patients became a new long-term opioid user. Pre-operative opioid use and affected body region were predictive for long-term opioid use. These findings, together with the observation that long-term opioid users want to taper opioids, emphasize the relevance of prevention, recognition and tapering support in the perioperative setting. LEVEL OF EVIDENCE: Level II. SIGNIFICANCE: Short-term opioid use can unintentionally progress to long-term opioid use. The prevalence of long-term opioid use after orthopaedic surgery varies widely and is mostly prescription-based, making it difficult to estimate the magnitude of the problem. This study assessed long-term postoperative opioid use in a full breadth orthopaedic population using patient reported measures, making conclusions much more robust. The prevalence of long-term postoperative opioid use in this study was 12.5%.

Aortic aneurysm: to tube or not to tube.

One hundred seventy-five patients underwent aortic aneurysm replacement from 1970 to 1977, and these patients were reviewed retrospectively as to the need for further aortic surgery because of progression of atherosclerosis or aneurysmal disease. A 99% (174 of 175) follow-up was obtained. Eighty-six patients had tube graft replacement operations. Selection of tube graft replacement as opposed to other operative techniques included physical examination, documentation of segmental pressures by Dopper studies, and aortography. Seventy-three percent of all patients undergoing aortic aneurysm replacement had angiography performed before surgery to demonstrate the location of the aneurysm as well as evidence of occlusive disease. Of the eighty-six patients with tube graft replacements (mean follow-up 4.86 years +/- 2 years), two patients required aortobifemoral grafting--one for iliac stenosis, the other for an occluded iliac artery secondary to a thrombosed femoral aneurysm. Only 6 of the 86 patients who underwent tube graft replacement developed symptoms of claudication. None of these patients required operation. This retrospective study demonstrates that placement of a tube graft for aortic aneurysm is a reliable operation in carefully selected patients. Few of these patients require repeat aortic surgery for occlusive or aneurysmal iliofemoral disease. Extensive follow-up of tube graft patients is discussed.

Examining cultural competence in health care: implications for social workers.

This article examines and unpacks the "black box" of cultural competence in health interventions with racial and ethnic minority populations. The analysis builds on several recent reviews of evidence-based efforts to reduce health disparities, with a focus on how cultural competence is defined and operationalized. It finds that the use of multiple similar and indistinct terms related to cultural competence, as well as the lack of a mutually agreeable definition for cultural competence itself, has resulted in an imprecise concept that is often invoked but rarely defined and only marginally empirically validated as an effective health intervention. This article affirms the centrality of cultural competence as an essential values-based component of optimal social work practice, while also suggesting future directions for operationalizing, measuring, and testing cultural competence to build an evidence base on whether and how it works to reduce health disparities.