Preoperative opioid use and postoperative return to work following spinal surgery in workers' compensation settings: a systematic review and meta-analysis.

BACKGROUND: Opioid use prior to spinal surgery is common among patients with workers' compensation (WC) claims. Extended opioid use for pain management in this population is associated with several adverse outcomes including delayed return to work (RTW). OBJECTIVE: This systematic review and meta-analysis aim to assess the evidence on the association of preoperative opioid use with stable RTW and RTW within 1-year after spinal surgery. MATERIAL AND METHODS: The authors searched MEDLINE, Embase, PsycINFO, Emcare, CINAHL Plus, Scopus, and Web of Science from inception to 14 January 2023. The authors included studies that compared any preoperative opioid use with no opioid use, and those that enabled a comparison of different durations of preoperative opioid use. The primary outcome was stable RTW after spinal surgery. Secondary outcomes were RTW within 1-year after surgery and cost of WC claims. A random effect model was assumed to pool the effect estimate. The GRADE approach was applied to evaluate the certainty of evidence. RESULTS: From 2589 records, 10 studies were included, and of these, nine were considered for quantitative synthesis. All studies were observational with eight retrospective cohort and two case-control studies. Five studies each investigated cervical and lumbar disorders. With moderate certainty evidence, the odds of postoperative stable RTW reduced by half (OR: 0.51, 95% CI: 0.43-0.59; 5549 participants) in patients using opioids preoperatively. Similarly, moderate certainty evidence from 2348 participants demonstrated that the odds of RTW within 1-year after surgery were reduced by more than half in patients with preoperative opioid prescriptions (OR: 0.46, 95% CI: 0.36-0.59). CONCLUSIONS: This systematic review and meta-analysis shows that preoperative opioid use is associated with a reduction in odds of postoperative RTW by half in patients with WC-funded spinal surgery.

Prescribing trend in cardiovascular patients at Ethiopian university hospital: The number of medications and implication on the clinical improvement.

Investigating the prescribing trend is important to improve rational prescribing. This study aimed at assessing the cardiovascular drug use, pattern, and its impact on clinical outcome. A cross-sectional study was employed in the outpatient department of chronic illness clinic of Gondar University specialized hospital, Ethiopia from 15 January 2017 to 15 March 2017. The independent variables were sociodemographic, medication, and other clinical information while cardiovascular disease improvement is the outcome variable. Binary logistic regression was used to test the association between the independent variables and the outcome variable. Kaplan Meier curve was used to analyze the clinical improvement while the Log-rank test was employed to compare the clinical outcome with the number of medications. Eight hundred thirty-three cardiovascular patient medical records were included in the final analysis. The majority (62.5%) of patients were females and more than 61% were above 50 years of age. Diuretics monotherapy accounted for a third (33.6%) of cardiovascular drug use, followed by combination therapy of angiotensin convertase enzyme inhibitors with Diuretics (21.8%) and calcium channel blockers with diuretics (8.3%). Cardiovascular patients followed for 72 months found to have a good level of clinical improvement on combination medication (Log Rank of 28.9, P = 0.000). In this study, diuretics monotherapy or in combination with angiotensin convertase enzyme inhibitors were found to be the frequently prescribed drugs in cardiovascular patients. Combination therapy has an implication for good cardiovascular improvement on long term follow-up. It seems clinicians were restricted to certain cardiovascular medications while plenty of choices are available from the diverse classes of cardiovascular drugs.

Off-label drug use in hospitalized children: a prospective observational study at Gondar University Referral Hospital, Northwestern Ethiopia.

Most of the medications which are currently used for the treatment of childhood diseases are either not licensed or being prescribed outside the terms of the product license (off-label prescribing). This study aimed at determining the extent of unlicensed and off-label drug uses and associated factors in children hospitalized in Gondar University Referral Hospital, Northwest Ethiopia. An institution-based prospective cross-sectional study was employed from April 15 to July 15, 2016. A total of 243 pediatric patients admitted to Gondar university referral hospital were included in the study using simple random sampling method. Data were collected using structured questionnaire, and the data collected were entered and analyzed using Statistical Packages for Social Sciences (SPSS) version 20. From the total of 800 drugs prescribed, 607 (75.8%) were off-label. Off-label medicine use was frequently observed in antimicrobials (60.6%) followed by central nervous system drugs (14.3%). The extent off-label prescribing was highest in age group of 6-13 years (30%). Inappropriate dosing and frequency (42.3%) were the most common reason for off-label medicine use. Having other variables controlled, age group and undergoing surgical procedure remained to be significant predictors of off-label prescribing in the multivariate regression analysis. Implementing evidence-based approach in prescribing by generating more quality literatures on the safety profile and effectiveness of off-label would improve the injudicious use of drugs in pediatric population.