RESUMO
OBJECTIVE: Cervical spine surgery (CSS) may be needed in those with refractory pain or neurologic deficits to improve outcomes in patients with cervical spine disease. However, consensus varies in the literature on the effect of surgery on opioid use. The objectives of this study were to analyze prescription rates of multiple controlled-substances before and after CSS and distinguish factors that may have contributed to opioid use after surgery. DESIGN: This is a retrospective cohort study analyzing prescription trends of various controlled substances in 632 patients who underwent CSS from 2019 to 2021. RESULTS: Opioids have the largest rise in prescriptions at 3- and 6-month time points after CSS. A significant association (p < 0.001) was found between opioid use one year prior to and one year after CSS. Exposure to opioids prior to surgery (OR 2.77, 95% CI 1.43, 5.51, p = 0.003) and higher morphine milligram equivalent (MME) dose (OR 1.02, 95% CI 1.01, 1.04, p = 0.012) were found to be associated to opioid use after surgery. Significantly more females were prescribed controlled substances (p = 0002). CONCLUSION: Higher MME dose and opioid exposure prior to surgery are important factors in predicting post-surgical opioid use.
RESUMO
OBJECTIVE: To investigate how common modifiable exposures, including dietary factors, select toxicants, and anti-inflammatory medications, may affect Parkinson's disease. METHODS: Using surveys, a case-control study was conducted at a medical center, comparing Parkinson's disease patients (N = 149) and healthy controls (N = 105). Subjects reported exposure to red meats, vegetables, alcohol, tobacco, anti-inflammatory medications, and pesticides. The relationship between exposures and Parkinson's disease diagnosis was analyzed by logistic regression to generate odds ratio and 95% confidence interval. RESULTS: Consuming red meat "sometimes" or "always" was positively associated with Parkinson's disease as compared to eating red meats "rarely" or "never"; (odds ratio = 2.15, 95% confidence interval = 1.06, 4.39; p = 0.03) and (odds ratio = 4.47, 95% confidence interval = 1.67, 11.94; p = 0.003), respectively. Exposure to pesticides showed a positive association with Parkinson's disease (odds ratio = 2.84, 95% confidence interval = 1.34, 6.00; p = 0.007). "Always" use of aspirin was inversely associated with Parkinson's disease (odds ratio = 0.32, 95% confidence interval = 0.14, 0.70; p = 0.004). "Ever" having used anti-histamines was inversely associated with Parkinson's disease (odds ratio = 0.37, 95% confidence interval = 0.17, 0.81; p = 0.01). DISCUSSION: Our study suggests that there are modifiable external factors that are associated with Parkinson's disease. The present study can thus assist clinicians, policy makers, and people living with Parkinson's disease in improving the experience and management of Parkinson's disease.