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Expectations of Lumbar Surgery Outcomes among Opioid Users Compared with Non-Users
Reisener Marie-Jacqueline,Hughes Alexander P.,Schadler Paul,Forman Alexa,Sax Oliver C.,Shue Jennifer,Cammisa Frank P.,Sama Andrew A.,Girardi Federico P.,Mancuso Carol A. 대한척추외과학회 2020 Asian Spine Journal Vol.14 No.5
Study Design: Matched cohort study. Purpose: To compare and describe the effect of opioid usage on the expectations of lumbar surgery outcomes among patients taking opioids and patients not taking opioids. Overview of Literature: Chronic opioid use is common among lumbar-spine surgery patients. The decision to undergo elective lumbar surgery is influenced by the expected surgery outcomes. However, the effects of opioids on patients’ expectations of lumbar surgery outcomes remain to be rigorously assessed. Methods: A total of 77 opioid users grouped according to dose and duration (54 “higher users,” 30 “lower users”) were matched 2:1 to 154 non-opioid users based on age, sex, marital status, chiropractic care, disability, and diagnosis. All patients completed a validated 20-item Expectations Survey measuring expected improvement with regard to symptoms, function, psychological well-being, and anticipated future spine condition. “Greater expectations” was defined as a higher survey score (possible range, 0–100) based on the number of items expected and degree of improvement expected. Results: The mean Expectations Survey scores for all opioid users and all non-users were similar (73 vs. 70, p=0.18). Scores were different, however, for lower users (79) compared with matched non-users (69, p=0.01) and compared with higher users (70, p=0.01). In multivariable analysis, “reater expectations” was independently associated with having had chiropractic care (p=0.03), being more disabled (p=0.002), and being a lower-dose opioid user (p=0.03). Compared with higher users, lower users were also more likely to expect not to need pain medications 2 years after surgery (47% vs. 83%, p=0.003). Conclusions: Patient expectations of lumbar surgery are associated with diverse demographic and clinical variables. A lower dose and shorter duration of opioid use were associated with expecting more items and expecting more complete improvement compared with non-users. In addition, lower opioid users had greater overall expectations compared with higher users.
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Rentenberger Colleen,Okano Ichiro,Salzmann Stephan N.,Shirahata Toshiyuki,Reisener Marie-Jacqueline,Shue Jennifer,Sama Andrew A.,Cammisa Frank P.,Girardi Federico P.,Hughes Alexander P. 대한척추외과학회 2021 Asian Spine Journal Vol.15 No.2
Study Design: Retrospective clinical study. Purpose: To describe postoperative height changes and identify the predictive factors of spinal height (SH) changes among patients with adult spinal deformity (ASD) who underwent circumferential lumbar fusion with instrumentation. Overview of Literature: Postoperative height changes remain an important issue after spinal fusion surgery that affects the overall satisfaction with surgery. Previous studies of postoperative height change have focused exclusively on young patients with adolescent idiopathic scoliosis (AIS). Methods: We retrospectively reviewed the clinical and imaging data of ASD patients who underwent lumbar corrective circumferential fusion of ≥3 levels (n=106). SH was defined as the vertical distance between C2 and S1 on a standing lateral image. As potential predictors of postoperative height change, the number of lateral lumbar interbody fusion (LLIF) levels, change in spino-pelvic parameters, total number of levels fused, and pedicle subtraction osteotomies (PSO) were documented. Univariate and multivariate linear regression analyses were performed to identify the predictors of postoperative height change. Results: The mean SH change was −2.39±50.8 mm (range, −160 to 172 mm). The univariate analyses showed that the number of LLIF levels (coefficient=10.9, p =0.03), the absolute coronal vertical axis change (coefficient=0.6, p =0.01), and the absolute Cobb angle change (coefficient=−0.9, p =0.03) were significant predictors for height change. Patients with PSOs (n=14) tended to have a shorter height postoperatively (coefficient=−26.1); however, this difference was not significant (p =0.07). Multivariate analyses conducted with variables of p <0.20 showed that pelvic tilt (PT) change is an independent contributor to SH change (coefficient=−0.99, p =0.04, R2 =0.11). Conclusions: Utilizing a modified definition of SH used in previous AIS studies, we demonstrated that patients with ASD lose SH postoperatively and that PT change was an independent contributor of SH change.
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Reisen, Helmut 세종대학교 국제경제연구소 1988 Journal of Economic Integration Vol.3 No.1
This paper tries to explore why debt problem persist in Brazil an Mexico, but not in Korea. It will discriminate among the many alternative hypotheses about the contrasting performances of Latin American versus East Asian debtor countries. This identifies a) past trade strategies, b) public debt levels, and c) fiscal rigidities to explain better than other determinants why Brazil's and Mexico's record is so poor compared with Korea's. Particular emphasis is given to the interaction of external competitiveness and fiscal retrenchment by discussing the impact of the foreign exchange rate on the public budget equation.
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