Ahmad Elsharydah

Complex regional pain syndrome type 1 predictors — Epidemiological perspective from a national database analysis

OBJECTIVE Complex regional pain syndrome type 1 is a disabling pain disorder with unclear etiology. It is usually triggered by an injury to a limb with or without specific nerve injury. The objective of this study is to explore the risk factors and predictors for this disease utilizing a large national database. DESIGN Retrospective analysis of the Nationwide Inpatient Sample database from 2007 to 2011 in the United States. SETTING AND PATIENTS Adult inpatients diagnosed with complex regional pain syndrome type 1. STATISTICAL ANALYSIS Chi-square, simple and multivariate logistic regression analyses were conducted. The regression model was adjusted to the patients demographics and comorbidities. MAIN RESULTS There were 22,533 patients with the discharge diagnosis of complex regional pain syndrome type 1 of an inpatient sample of 33,406,123. It peaks between age 45 and 55. Female gender, Caucasian race, higher median household income, headache, depression, drug abuse and private insurance patients (vs Medicaid patients) were associated with higher rate of complex regional pain syndrome type 1. On the other hand, diabetes, obesity, hypothyroidism, and anemia were associated with a lower rate. CONCLUSIONS Utilizing a large database, our study added more information to the risk profile of the complex regional pain syndrome type 1 in an inpatient population. Such information should be useful for physician for early recognition, diagnosis of patients at risk.

Retained surgical items after abdominal and pelvic surgery: Incidence, trend and predictors- observational study

Introduction Surgical retained items (RSIs) are associated with increase in perioperative morbidity and mortality. We used a large national database to investigate the incidence, trends and possible predictors for RSIs after major abdominal and pelvic procedures. Methods The nationwide inpatient sample data were queried to identify patients who underwent major abdominal and pelvic procedures and discharged with secondary ICD-9-CM diagnosis code of (998.44 and 998.7). McNemars tests and conditional logistic regression analyses of a 1:1 matched sample were conducted to explore possible predictive factors for RSI. Results RSI incidence rate was 13 in 100,000 cases-years from 2007 to 2011 after major abdominal and pelvic procedures. RSI incidence remained steady over the five-year study period. Rural hospitals and elective procedures were associated with a higher RSI incidence rate [(OR 1.391, 95% CL 1.056–1.832), p = 0.019] and [(OR 1.775, 95%CL 1.501–2.098), p < 0.001] respectively. Conclusions Our study was able to add more to the epidemiological perspective and the risk profile of retained surgical items in abdominal and pelvic surgery. Surgical cases associated with these factors may need further testing to rule out RSI.

Epidural analgesia utilization rate for hepatic and pancreatic surgery, that low?

I read with interest the article ‘‘A nationwide analysis of the use and outcomes of perioperative epidural analgesia in patients undergoing hepatic and pancreatic surgery’’. I congratulate the authors for this important analysis and their publication in your esteemed journal; however, I have few concerns about this study I would like the authors to address. The 1st concern is the low postoperative epidural analgesia (EA) utilization rate (7.4%) reported in this study for the selected surgical procedures. I have been involved in the last few years with similar analyses using the same database, the Nationwide Inpatient Sample (NIS) of the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality. NIS data are extracted from a sample of United States community hospitals discharge information. The NIS contains clinical and resource use information included in a typical discharge abstract (http://www.hcup-us.ahrq.gov/db/nation/nis/NIS Introduction2012.pdf, last accessed 9/8/2015). It is derived from billing data submitted by hospitals to statewide data organizations across the country. Hospitals are required by the law (Health Insurance Portability and Accountability Act) to use only International Classification of Diseases (ICD) codes (currently ICD-9-CM) for their inpatient hospital charges bills. Many hospitals bill for EA using Current Procedural Terminology (CPT) codes not ICD codes, as a physician service which is usually performed by an anesthesiologist. Generally, postoperative analgesia is considered a surgeon responsibility and is part of the global surgery package rule. For the anesthesiologist to be able to bill for this service, the surgeon has to consult the anesthesiologist to perform the procedure and manage the EA during the postoperative period. Because NIS does not track CPT codes, therefore these data are missing from NIS leading to significant underestimation in EA utilization rate. Several studies used other databases such as Medicare database and used CPT codes showed significantly higher

Effects of epidural analgesia on recovery after open colorectal surgery

The use of epidural analgesia (EA) has been suggested as an integral part of an enhanced recovery program for colorectal surgery. However, the effects of EA on postoperative outcomes and hospital length of stay remain controversial. Data from the American College of Surgeons National Surgical Quality Improvement Program database for 2014 and 2015 were queried for adult patients who underwent elective open colorectal surgery. We included only cases with general anesthesia as the main anesthetic. Cases with other types of anesthesia were excluded. A 1:3 matched sample of EA versus non-EA cases was created based on propensity scores. The primary outcome of interest was the occurrence of major cardiopulmonary complications within 7 days of the surgery. Secondary outcome measures were hospital length of stay and 30-day mortality. A total of 24,927 patients were included in the analysis. EA was utilized in 15.02% (n = 3745). The cumulative risk over the study period for major cardiopulmonary complications was 2.52% (n = 627). There were no statistically significant differences in the rate of postoperative complications (relative risk 0.91, 95% CI 0.66–1.27, P = 0.59), length of stay (median [interquartile range], EA 6 [5–9] versus non-EA 6 [4–9] days, P = 0.36), and 30-day mortality rate (relative risk 0.71, 95% CI 0.42–1.20, P = 0.20) between the two propensity-matched cohorts. In conclusion, our study revealed that the benefits of EA in patients undergoing open colorectal surgery are limited, as it does not influence immediate postoperative cardiopulmonary complications or hospital length of stay.

Propofol reduces succinylcholine-induced muscle rigidity in a patient with paramyotonia congenita

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Upper airway trauma during general anaesthesia for major surgery: Incidence and trends: A retrospective study

First, awake fibreoptic intubation includes two parts, airway topical anaesthesia and then subsequent intubation. A limitation of this study design is the lack of evaluation of patient comfort during topical anaesthesia of the airway. It is generally believed that translaryngeal application of local anaesthetics often incites powerful coughing and patient discomfort. Furthermore, local anaesthetic injected into the airway is nebulised and distributed over the infraglottic and supraglottic structures by the patient’s coughing. In contrast, airway spray of a local anaesthetic with a fibreoptic bronchoscope using a ‘spray-as-you-go’ technique produces only low levels of discomfort for patients.