Victoria Goode

BACKGROUND: The purpose of this study was to describe the pre- and postsurgical opioid prescription rates and average morphine milligram equivalents (MME) per day in patients undergoing total shoulder replacement (TSR) procedures. METHODS: Patients undergoing TSR were identified from the electronic health records (EMR). In addition to patient demographics, opioid prescription 12-months presurgery and postsurgery were recorded. Patients were categorized into two groups: patients with no opioid prescriptions within 12 months before surgery and patients with an opioid prescription after surgery. McNemar tests were conducted to test for significant presurgical to postsurgical changes in opioid rate changes. The Wilcoxon signed rank test was used to test for significant pre- to postsurgical changes in average MME/day/person, and bivariate logistic regression analyses and covariate-adjusted logistic regressions were used to predict postsurgical opioid prescriptions. RESULTS: Overall, 1,076 patients underwent TSR. More than 900 patients received presurgical opioid prescriptions. There was a significant increase (p = .0015) in pre-surgical to postsurgical prescription rates. Postsurgical opioid prescriptions were 4.6 times more likely to be prescribed to a pre-surgical non-opioid patient than an opioid patient (p < .0001). Among those prescribed an opioid, the median dosage was <50 MME/day and over 82% of patients were at low overdose risk. Patients with comorbidities and without pre-surgical alcohol use were more likely to receive postsurgical opioids. Postsurgical opioid prescriptions were 4.6 times more likely to be prescribed to a presurgical non-opioid patient than an opioid patient (p < .0001). More than 80% of patients undergoing TSR received presurgical opioids. Among those prescribed any opioid, the median dosage was <50 MME/day and greater than 82% of patients were at low overdose risk. CONCLUSIONS: Although presurgical non-opioid patients were more likely to receive a postsurgical opioid prescription, based on dosage, most patients were at low risk for an opioid-related overdose or death according to CDC guidelines.

PURPOSE: Stress-induced hyperglycemia during the perioperative period is associated with adverse outcomes after spinal surgery, which increases both patient-related burden and hospital costs. This quality improvement project describes the development and implementation of a perioperative blood glucose monitoring protocol for patients undergoing spinal surgery. DESIGN: An evidence-based perioperative blood glucose monitoring protocol was developed by a multidisciplinary committee of specialists in endocrinology and anesthesiology with utilization of the American Diabetes Association diabetes screening criteria. METHODS: The protocol was implemented in the perioperative areas of a regional hospital in the Southeastern United States. The project sample included patients with and without a prior diagnosis of diabetes who met protocol inclusion criteria during a 3-month implementation period. FINDINGS: Preoperative glycated hemoglobin (HbA1c) testing identified more than 54% of previously undiagnosed patients with levels consistent with either prediabetes or diabetes according to the American Diabetes Association criteria for diagnosis. Patients with diabetes and those without diabetes experienced a perioperative increase in blood glucose with levels remaining elevated above preoperative baseline through postoperative day 1. CONCLUSIONS: A perioperative blood glucose monitoring protocol enables preoperative identification of patients with undiagnosed prediabetes and diabetes, allowing for optimization before elective surgery and establishment of appropriate postoperative follow-up care. In addition, a blood glucose monitoring protocol increases the detection of perioperative hyperglycemia and may lead to a reduction in postoperative complications after spinal surgery.

Researchers need to evaluate the strengths and weaknesses of data sets to choose a secondary data set to use for a health care study. This research method review informs the reader of the major issues necessary for investigators to consider while incorporating secondary data into their repertoire of potential research designs and shows the range of approaches the investigators may take to answer nursing research questions in a variety of context areas. The researcher requires expertise in locating and judging data sets and in the development of complex data management skills for managing large numbers of records. There are important considerations such as firm knowledge of the research question supported by the conceptual framework and the selection of appropriate databases, which guide the researcher in delineating the unit of analysis. Other more complex issues for researchers to consider when conducting secondary data research methods include data access, management and security, and complex variable construction.