Influence of preoperative psychotropic medications on opioid requirements and outcomes following bariatric surgery.

INTRODUCTION: Opioid use continues to impose a substantial burden on the healthcare system. Multiple studies suggest that depression and psychosis increase the risk of chronic opioid use. We hypothesized that patients' pharmacologic profiles would affect postoperative opioid requirements following bariatric surgery. MATERIALS AND METHODS: Retrospective analysis identified patients who underwent laparoscopic bariatric surgery at a high-volume center from 2014 to 2016. Prescriptions from one year prior through 3 months after surgery were collected. Patients with complicated operative courses were excluded. RESULTS: A total of 201 patients met inclusion criteria. Forty-six patients(23%) required an opioid refill within 3 months of surgery. Opioid exposure was strongly associated with need for repeat opioid prescription(OR 3.1, p = 0.001). When controlled for preoperative opioid exposure, antidepressant and antipsychotic use showed no such association. Patients using antipsychotics were significantly more likely to have complicated postoperative courses(OR 2.25, p = 0.043). CONCLUSIONS: Opioid exposure increased the risk of chronic opioid requirements after surgery, but other psychotropic medications showed no such effect. Patients using anti-psychotics may be prone to surgical complications making them vulnerable to chronic opioid use.

Quality Assurance During a Global Pandemic: An Evaluation of Improvised Filter Materials for Healthcare Workers.

OBJECTIVE: The proliferation of improvised masks during the COVID-19 pandemic has raised questions regarding filter effectiveness and safety. We sought to compare the effectiveness of commonly used improvised filter materials against N95 industry standards. METHODS: Six different filter materials commonly used in the community were tested using both single- and multi-layer configurations with the TSI 8130 automated filter tester in accordance with National Institute for Occupational Safety and Health (NIOSH) standards for N95 respirators. RESULTS: Only three of the tested filter material configurations met N95 parameters with regard to filtration efficiency and pressure drop across the filter material-the: True-high-efficiency particulate air (HEPA) filter, four-layer MERV 13 and 14 HVAC filters. CONCLUSIONS: Many proposed filter materials for improvised masks do not meet current industry standards and may pose safety and efficacy concerns. Care should be taken when selecting materials for this critical respirator component, particularly for health care workers or others at high risk for pathogen exposure.