Patient-reported Allergies Research Articles

The Effect of Patient-Reported Allergies on Patient-Reported Outcomes in Carpal Tunnel Release.

Patient-reported allergies have been shown to be a risk factor for poor surgical outcomes in a variety of orthopedic procedures. The relationship between patient-reported allergies and outcomes in carpal tunnel surgery remains unclear. A retrospective electronic medical chart review was conducted on 390 patients who underwent primary carpal tunnel releases, without concomitant procedures, who completed preoperative and postoperative Quick Disabilities of Arm, Shoulder, and Hand or Patient-Rated Wrist Evaluation scores, with a minimum of 1-year follow-up. Patient demographic data and patient-reported outcome measures were collected. Patients were grouped based on the number of allergies reported (≤3 allergies or ≥4 allergies), and statistical analysis was performed. Three hundred and ninety patients were included in the analysis (347 patients [89.0%] with ≤3 allergies; 43 patients [11.0%] with ≥4 allergies). Patients were predominantly female (n = 243, 62.3%), and the median age at surgery was 61 years. Patients with ≥4 allergies were more likely to be female (88.4% vs 59.1%), older (64.3 years vs 60.3 years), and more likely to be taking psychotropic medication (51.2% vs 28.2%). No differences were seen in patient-reported outcomes at any time point preoperatively or postoperatively, with both groups showing similar postoperative improvement. Patients with a high number of reported allergies have similar improvement in patient-reported outcomes following carpal tunnel release as low-allergy cohorts.

Immune Hypersensitivity Is Associated With Higher Graft Failure Rate After Osteochondral Allograft Transplantation of the Knee

To analyze the effects of 1 or more patient-reported allergies on clinical outcomes, in particular graft failure rate, and patient-reported outcomes (PROs) following osteochondral allograft transplantation (OCA) of the knee. Retrospective review of patients who underwent knee OCA from August 2010 to May 2021 with a minimum of 2-year follow-up. Patients were initially divided into 2 cohorts: those with at least 1 allergy and those without any allergies. Clinical outcomes assessed included graft failure, reoperation rates, deep vein thrombosis/pulmonary embolism, and manipulation under anesthesia/lysis of adhesions (MUA/LOA). PROs assessed, including the visual analog scale (VAS) for pain and satisfaction, the Knee injury and Osteoarthritis Outcome Score (KOOS), and return to sport rates, were compared. In total, 285 patients were included with a mean clinical follow-up of 4.8 ± 2.0 years. The allergy cohort had a significantly higher rate of graft failure (P= .008). In a regression analysis controlling for confounding variables, graft failure remained significantly associated with the presence of medication allergies (odds ratio [OR], 3.631; 95% CI, 1.139-11.577; P= .029). Furthermore, an increasing number of allergies were associated with an increased rate of graft failure (OR, 1.644; 95% CI, 1.074-2.515; P= .022). There was no difference in rate of reoperation, complications, infection, and MUA/LOA. Of the 100 patients who completed PROs, there was no difference in VAS satisfaction, pain, and any of the KOOS outcome scores or return to sport. The presence of 1 or more patient-reported allergies was shown to be significantly associated with OCA graft failure. Furthermore, an increasing number of patient-reported allergies were associated with a higher rate of graft failure. However, there were no significant differences in VAS satisfaction or pain, KOOS symptom, quality of life, pain, or return to sport in patients with at least 1 patient-reported allergy and those without allergies. Level III, retrospective cohort study.

Impact of Patient-Reported Allergies on Post-operative Complications and Healthcare Utilization Following Carpal Tunnel Release.

Open carpal tunnel release (O-CTR) is associated with high patient satisfaction and low complication rates. Risk factors for complications are well-established. Recent studies have found that patient-reported allergies (PRAs) and psychiatric comorbidities may be associated with increased complication rates. The impact of these factors after elective hand surgery has not been evaluated. This study sought to identify whether PRAs and psychiatric comorbidities are associated with complications after O-CTR and to evaluate their association with prolonged follow-up and the need for post-operative occupational therapy (OT). Patient demographics, PRAs, Patient Health Questionnaire-2 score, CharlsonComorbidity Index, Carpal Tunnel Symptoms-6 score, postoperative complications, OT utilization, and time to final follow-up were recorded for patients who underwent elective O-CTR between 2014 and 2022. Multivariable binomial logistic regression analysis was used to determine pre-operative variables associated with increased risk for complication. About 250 patients met the inclusion criteria. Fifty-one (20.4%) patients developed minor complications, including scar tenderness (N=34, 13.6%), superficial wound dehiscence (N=9, 3.6%), and superficial infection (N=8, 3.2%). There were no major complications. Independent risk factors for complications included PRAs (OR 1.80, p<0.01) and PHQ-2 score (OR 1.39, p=0.04). Five or more PRAs and PHQ-2 score ≥3 are significant independent risk factors for increased post-operative complications. Increased PRAs and PHQ-2 scores were associated with longer follow-up (p=0.01 and p<0.01, respectively) but not increased OT utilization. An increased number of PRAs and higher PHQ-2 scores are significant, independent risk factors for minor complications following O-CTR. Risk adjustment and peri-operative counseling should incorporate and account for these variables.

Patient Self-Reported Allergies and Their Correlation with Thoracic Outlet Syndrome Outcomes.

Thoracic outlet syndrome (TOS) is an uncommon neurovascular disorder that presents as neck and upper extremity pain secondary to brachial plexus trunk or subclavian vasculature compression. The orthopedic literature has correlated patient-reported allergies to postoperative patient-reported outcome (PRO) scores for a variety of surgical procedures. We sought to evaluate patient-reported allergies and PROs following surgical decompression for TOS. A chart review was conducted after identifying patients who underwent surgical thoracic outlet decompression by a single surgeon. Patients were contacted and administered five PRO questionnaires via telephone: the QuickDASH Outcome Measure questionnaire (disabilities of the arm, shoulder, and hand [DASH]), the Cervical Brachial Symptom Questionnaire, the Single Assessment Numeric Evaluation, the 12-Item Short Form Survey, and the Numeric Rating Scale (a visual analogue scale). A bivariate analysis of Pearson's correlation coefficient (r) was used to determine the associations of allergies with questionnaires and demographic variables. Of the 393 patients (128 males and 265 females) identified in the study, 75 (24%) responded and completed all of the questionnaires, 18 (24%) males and 57 (76%) females. A significant correlation was found between the number of allergies reported and the QuickDASH Outcome Measure questionnaire (r = 0.375, P < 0.001), the Cervical Brachial Symptom Questionnaire (r = 0.295, P = 0.01), change in the Single Assessment Numeric Evaluation score (r = -0.310, P < 0.01), change in the visual analogue scale (r = 0.244, P = 0.035), sex (r = 0.245, P = 0.034), and the number of medications (r = 0.642, P < 0.001). The increased frequency of patient-reported allergies is significantly associated with worse PRO scores for women undergoing TOS surgical decompression. Better understanding this association can help physicians counsel patients on expected outcomes.

Patient-reported allergies are associated with increased rate of postoperative stiffness after arthroscopic rotator cuff repair

Several risk factors have been identified for the development of postoperative shoulder stiffness, and there has been increasing interest in orthopedic literature regarding patient-reported allergy (PRA) as an identifiable risk factor for adverse outcomes. The purpose of this study is to determine whether PRAs are associated with subsequent rates of diagnosis of adhesive capsulitis (AC) or return to the operating room for postoperative shoulder stiffness within two years following arthroscopic rotator cuff repair (ARCR). Patients were retrospectively identified using Current Procedural Terminology surgical billing codes to identify patients who underwent ARCR at a single urban academic institution from January 2012 to December 2020 with minimum 2-year follow-up. Lysis of adhesions (LOA), MUA, and adhesive capsulitis of the shoulder were further queried within two years postoperatively for the ipsilateral shoulder. Patients were excluded if they had undergone ipsilateral MUA/LOA or received a diagnosis of AC prior to the index procedure. Demographic characteristics and medical comorbidities (hypertension, diabetes, hyperlipidemia, hypothyroidism) were extracted from electronic medical records. Baseline characteristics were compared between patients with and without PRAs. Multivariate logistic regression analyses were performed to determine the association of the presence of PRAs overall, as well as presence one, two, or three or more PRAs, with subsequent MUA/LOA or diagnosis of AC within two years postoperatively. Of 7,057 patients identified in the study period, 6,583 patients were eligible for the final analysis. The mean age was 56.6±11.7 years and the mean BMI was 29.1±5.6. Overall, 19.3% of patients (n=1,271) reported at least one allergy and 7.1% (n=469) had >1 PRA. 44 patients (0.7%) underwent subsequent ipsilateral MUA/LOA within two years postoperatively, while 93 patients (1.4%) received a diagnosis of ipsilateral AC in the same time frame. PRAs were significantly associated with subsequent diagnosis of AC (OR 2.39; 95% CI [1.45-3.92]; p<.001), but not MUA/LOA (OR 1.97, 95% CI [1.26-3.61]; p=0.133). Patients with two PRAs had greater odds of being diagnosed with AC than patients with one PRA (OR: 2.74; 95% CI [1.14-5.99]; p=0.012). While this association was non-significant for MUA/LOA, patients with 2 PRAs (OR: 2.67; 95% CI [0.96-8.80]; p=0.059) demonstrated a similar statistical trend. Patient-reported allergies are associated with increased odds of receiving a diagnosis of adhesive capsulitis within two years following arthroscopic rotator cuff repair, but were not found to be associated with return to the operating room for postoperative stiffness.

Patient-Reported Allergies Do Not Affect Long-Term Patient-Reported Outcome Measures After Spine Surgery.

A gap in the literature exists regarding the association between number of allergies and patient-reported outcomes measures (PROMs) for patients undergoing spine surgery. Consecutive cervical or lumbar spine surgery patients were identified from a prospective registry from April 2017 to July 2020. Patients were grouped into those with 0, 1, 2, or ≥3 allergies. Demographics were compared between the groups. PROMs included Neck Disability Index, Oswestry Disability Index, visual analog scale (VAS) neck pain, VAS arm pain, VAS back pain, VAS leg pain, short form 12 (SF-12) physical component score, SF-12 mental component score, and patient-reported outcomes measurement information system physical function (PROMIS-PF), and outcomes were compared between the groups through multivariable analysis at up to 1-year follow-up. Associations between number of allergies and achieving a minimal clinically important difference (MCID) in the 9 aforementioned PROMs at 1-year follow-up were assessed. This study included 148 cervical and 517 lumbar patients. After controlling for demographic differences, a higher number of allergies was associated with less improvement in VAS neck pain, SF-12 physical component score, and PROMIS-PF at 12 weeks following cervical surgery and less improvement in PROMIS-PF at 2 weeks following lumbar surgery (P < 0.05). However, these associations failed to persist after 6 months and 12 weeks following surgery in cervical and lumbar patients, respectively (P > 0.05). No association was identified between number of allergies and achievement of MCID in any of the 9 studied PROMs at 1-year follow-up. The higher number of allergies was associated with less improvement in PROMs in the early postoperative period but not at longer-term follow-up. These findings provide data that can be utilized while counseling patients and setting postoperative expectations.

Does severe preoperative shoulder pain affect postoperative outcomes after reverse total shoulder arthroplasty

BackgroundThe purpose of this study is to determine the improvement of pain and postoperative function after reverse total shoulder arthroplasty (rTSA) in patients who have severe preoperative pain. We hypothesized that these patients would have lower postoperative function and not experience the same scaled improvement as other patients. MethodsAfter the application of exclusion criteria, 214 patients who underwent primary rTSA in a 6-year period and had at least one year outcome data met the inclusion criteria. Age, demographics, preoperative, and 1-year postoperative pain visual analog scale (VAS) were recorded, range of motion (ROM), subjective shoulder value (SSV), and postoperative shoulder outcome scores (American Shoulder and Elbow Surgeons, Simple Shoulder Test, University of California-Los Angeles, and Constant) were collected. Additional information, such as number of patient-reported allergies, history of anxiety/depression, preoperative use of antidepressants/anxiolytics/psychotropics, and preoperative opioid usage, were also obtained. Patients were separated into two cohorts as follows: severe preoperative pain (VAS scores of 9-10, n = 114) and lower preoperative pain (VAS scores < 9, n = 110). ResultsPatients with severe preoperative pain had significantly lower preoperative SSV and ROM in each category compared to the other cohort. Postoperative differences in VAS, ROM, and outcome scores were not significant between the severe preoperative pain cohort and the lower preoperative pain cohort. When examining the changes in outcomes from preoperatively to postoperatively, patients with severe preoperative pain experienced statically significant improvements in VAS, SSV, and all ROM measurements except for active external rotation. No significant differences were seen in the number of patient-reported allergies, tobacco usage, history of anxiety/depression, usage of antidepressants/anxiolytics/psychotropics, or preoperative opioid usage between the two groups. Discussion and ConclusionThis study demonstrated that patients with severe preoperative pain had significantly lower shoulder function preoperatively. However, these patients had similar outcomes after rTSA compared to other patients undergoing the same procedure who did not report severe preoperative pain. Further, these patients experience a significant increase in shoulder function and decrease in pain after rTSA compared to preoperative assessments, in contrast to other patients who did not report severe preoperative pain.

Increasing patient-reported allergies are not associated with pain, functional outcomes, or satisfaction following medial patellofemoral ligament reconstruction: a retrospective comparative cohort study

BackgroundPatient-reported allergies (PRAs) are often stigmatized as a potential nonmodifiable risk factor for increased pain and worse functional outcomes following surgery. However, there is a dearth of literature directly assessing the impact of PRAs on outcomes in sport surgeries such as medial patellofemoral ligament reconstruction (MPFLR). The purpose of our study was to determine whether PRAs were associated with worse outcomes following MPFLR.MethodsWe conducted a retrospective review of patients who underwent MPFLR at our institution from 2011 to 2019. Patients were included if they had at least 12 months of follow-up. PRAs were obtained from preoperative medical assessments and categorized by drug class. Demographic and perioperative data were obtained from electronic medical records. Postoperative outcomes were measured using a telephone survey and included recurrent instability, Visual analog scale (VAS) for pain, VAS for sports, Kujala score, MPFL-Return to Sport after Injury (MPFL-RSI) score, and overall satisfaction score. Multiple linear regression was used to determine association between PRAs and outcome measures, and p-values less than 0.05 were considered significant.ResultsThe cohort included 141 MPFLR. Most patients were female (98, 70%) with an average age of 25 years (range 12–56 years). Average follow-up time was 47 months. Forty-seven patients (33%) reported at least one PRA. There were no significant differences in postoperative pain, functional outcomes, satisfaction, or return to sport between patients with or without PRAs (all p > 0.05). Absence of antibiotic PRAs was predictive of higher VAS (p < 0.007), but there were no other differences. There were no significant differences in outcomes between patients without PRAs, PRAs without a concomitant psychiatric disorder, or PRAs with a concomitant psychiatric disorder (all p > 0.05).ConclusionsIn conclusion, PRAs with or without concomitant psychiatric diagnoses are not associated with worse postoperative pain, functional outcomes, or satisfaction following MPFLR with allograft, dispelling common misconceptions that increased number of allergies or psychiatric diagnoses lead to inferior surgical outcomes. Presence of antibiotic allergies was associated with lower VAS postoperative pain score. Future research should investigate the relationship between PRAs and other surgeries in the field of sports medicine.

Are Patient-Reported Drug Allergies Associated With Prosthetic Joint Infections and Functional Outcomes Following Total Hip and Knee Arthroplasty?

The purpose of this study is to determine if the number and types of patient-reported drug allergies are associated with prosthetic joint infection (PJI) and functional outcomes following total joint arthroplasty (TJA). This is a retrospective review of all patients who underwent a primary, elective total hip (THA) or knee arthroplasty (TKA) over a 10-year period at a single academic institution. Demographic, clinical information, and number and type of patient-reported drug allergy was collected. Univariate and multivariate logistic regressions were performed to identify risk factors for PJI and risk of PJI based on number of allergies. Univariate analysis was also performed to identify if the number of patient-reported allergies affected functional outcome scores. Of 31,109 patients analyzed, there were 941 (3%) revisions for infection (491 knees and 450 hips). At least one allergy was reported by 16,435 (52.8%) patients, with a mean of 1.2±1.9. Those who underwent revision for infection had a significantly higher number of reported allergies (1.68±1.9 vs 1.23±1.9, P < .0005, 95% confidence interval-0.58 to 0.33). On univariate regression the number of allergies independently predicted revision TJA for infection (P < .0001) as did age, gender, body mass index, and smoking status. On multivariate regression for each additional patient-reported allergy, risk of PJI increased by 1.11 times (95% confidence interval 1.07-1.14, P < .0001). Number of patient-reported allergies did not predict 3-month or 1-year functional outcome scores. Patients with a higher number of reported allergies may be at increased risk of PJI following TJA. Prognostic Level II.

The effects of beta-lactam allergy relabeling on antibiotic prescribing practices

BackgroundBeta-lactam antibiotic allergy labels are highly prevalent but rarely indicate an allergic intolerance. These patient-reported allergies lead to broad-spectrum antibiotic use, conferred resistance, increased expense, and adverse effects. ObjectiveTo implement and assess the impact of a history-based clinical guideline that directs antibiotic management and beta-lactam allergy relabeling for patients reporting beta-lactam allergies. MethodsPatients with beta-lactam allergy labels were identified by our trained multidisciplinary team in diverse clinical settings. This quality improvement project was conducted to evaluate the safety and impact of the guideline on antibiotic use by comparing prescribing practices before and after guideline implementation. ResultsA total of 79 patients with beta-lactam allergies were identified (penicillins-90%, cephalosporins-10%). After guideline implementation, outcomes of allergy relabeling included the following: (1) complete removal, indicating an unlikely true allergy (27%); (2) updated to detail successfully tolerated beta-lactam courses (48%); or (3) no change made to current label (25%). Beta-lactam antibiotic courses before and after guideline implementation compared with total antibiotic courses: allergy removed (44% vs 70%; P < .001), allergy updated (32% vs 68%; P < .001), and no change (27% vs 41%; P = .08). Compared with before guideline implementation, beta-lactam antibiotics were 3 times more likely to be prescribed after allergy assessment (odds ratio, 3.22; 95% confidence interval, 2.4-4.3; P < .05). ConclusionThe implementation of the beta-lactam allergy clinical guideline resulted in most patients’ allergy labels being removed or advantageously updated. These allergy label changes correlated with a substantial increase in the percentage of beta-lactam antibiotics prescribed. After guideline implementation, beta-lactam antibiotics had a 3-fold increased odds of being prescribed independent of allergy label outcome.

Patient-reported drug and latex allergies negatively affect outcomes after total and reverse shoulder arthroplasty.

Patient-reported allergies (PRAs) have been identified as a risk factor for worse outcomes and less satisfaction in patients undergoing knee and hip arthroplasty. Similar associations have not been elucidated in shoulder arthroplasty patients; however, previous research is sparse. The purpose of this study was to assess the outcomes following shoulder arthroplasty surgery with respect to patient-reported drug allergies. It was hypothesized that a higher number of allergies would be associated with worse patient-reported outcomes (PROs) following shoulder arthroplasty surgery. Consecutive patients aged 18-89 years at the time of surgery who underwent primary shoulder arthroplasty between October 2005 and March 2018 performed by a single surgeon and had a minimum follow-up period of 1 year were reviewed. PRO scores, including the American Shoulder and Elbow Surgeons score, Single Assessment Numerical Evaluation score, QuickDASH (short version of Disabilities of the Arm, Shoulder and Hand questionnaire) score, and 12-Item Short Form Health Survey Physical Component Summary and Mental Component Summary scores, as well as patient satisfaction, were collected preoperatively and postoperatively. Early clinical failures were reported. Subjects were categorized into a 3-level factor based on the number of PRAs (0, 1, or ≥2), and bivariate comparisons of mean postoperative PRO scores were performed using Kruskal-Wallis analyses. Additionally, multivariate regression was performed to assess the effect of PRAs on PROs while controlling for age, sex, arthroplasty type, baseline PRO scores, and Charlson Comorbidity Index. Overall, 411 shoulders were included in the final study population (367 patients, 44 of whom were treated bilaterally). The population was predominately male patients (n = 265, 64.5%), and the median age at the time of surgery was 66.5 years (first quartile-third quartile, 61.3-71.4 years). Of the patients, 253 (61.6%) underwent total shoulder arthroplasty (TSA) whereas 158 (38.4%) underwent reverse TSA. Five patients (2 TSA and 3 reverse TSA patients) experienced early clinical failure and required revision surgery. Minimum 1-year PROs were obtained for 345 of 406 patients (85.0%) with a mean follow-up period of 1.9 ± 1.2 years. Nearly all postoperative PROs reflected a trend of worse outcomes with more preoperative PRAs; however, the QuickDASH score was the only score showing a significant difference between allergy groups (P = .004). Pair-wise comparison using Nemenyi post hoc testing showed that the QuickDASH score was significantly higher (worse outcomes) for the group with ≥2 allergies compared with the group with 0 allergies. PRA was found to be a statistically significant predictor of higher postoperative QuickDASH scores (P = .043) and was more influential than the Charlson Comorbidity Index and sex. Additionally, PRA was the only statistically significant predictor of patient satisfaction (P = .016). An increasing number of preoperative PRAs is associated with worse PROs and patient satisfaction following shoulder arthroplasty. The number of PRAs was the most influential predictor of patient satisfaction.

Patients Who Do Not Receive Aspirin Because of Allergy Have an Increased Risk of Venous Thromboembolism Following Total Joint Arthroplasty.

Patient-reported allergies to aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) may preclude certain patients from receiving aspirin as venous thromboembolism (VTE) prophylaxis after total joint arthroplasty (TJA). The purpose of the study was to (1) determine whether the use of non-aspirin agents due to a self-reported aspirin or NSAID allergy was associated with a higher incidence of VTE and (2) determine the rate of true allergic reactions in patients who reported an allergy but still received aspirin. Prospectively collected data from 45,171 patients who underwent primary TJA between 2000 and 2019 were reviewed. Patients who reported an allergy to aspirin or NSAIDs were identified (n = 823). Using a validated VTE risk calculator, each patient was assigned a risk score based on 26 comorbidities. Bleeding complications, VTEs that occurred within 90 days postoperatively, and allergic reactions were collected as end points. Multivariable logistic regression was performed to determine the factors associated with VTE. The overall incidence of aspirin or NSAID allergy was 1.8%. Only 80 of 267 patients (30%) reported an allergy to only aspirin and still received aspirin. Compared with patients who received aspirin without a history of allergy (n = 17,648), patients who received non-aspirin thromboprophylaxis due to allergy (n = 383) had a higher incidence of VTE (2.87% versus 0.24%, p < 0.001). On multivariable regression, these patients had an 8-fold increase in VTE risk (adjusted odds ratio, 7.94; 95% confidence interval, 2.86 to 22.07; p < 0.001). The incidence of true allergic reactions to aspirin among those with a reported allergy was 1.8% (number needed to harm = 55). No patients developed anaphylaxis or severe hypersensitivity reactions. Patients with a self-reported allergy to aspirin or NSAIDs were at a significantly increased risk for VTE if they received non-aspirin thromboprophylaxis agents following TJA. Future research should evaluate the usefulness of preoperative allergy testing when selecting a VTE prophylactic agent in patients with self-reported allergies. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Do Self-Reported Drug Allergies Influence Clinically Significant Outcome Improvement Following Osteochondral Allograft Transplantation? A Nested Cohort Study.

To compare clinical outcomes for patients who underwent osteochondral allograft transplantation (OCA) based on the presence or absence of one or more self-reported drug allergies. Prospective data were collected from 245 consecutive patients after OCA of the knee from one large academic institution. Patient-reported allergies were obtained via chart review. Patient-reported outcome measures, including activities of daily living of the Knee Outcome Survey (KOS-ADL), Marx Activity Scale, International Knee Documentation Committee (IKDC), and visual analogue scale (VAS) pain were all collected. The minimal clinically important difference (MCID) for each outcome was quantified using a distribution-based method. Independent t tests were used to compare patient-reported outcome measures between those with and without self-reported allergies, while chi-square analysis of association was used to compare rates of MCID achievement. Of 245 patients included, 83 (33.9%) reported having at least one drug allergy at the time of OCA. There were no statistically significant differences with regard to patient demographics, including age, body mass index, gender, or sports participation between those with and without a reported allergy. Similarly, there were no significant differences found between baseline preoperative patient-reported outcomes. Overall, both cohorts demonstrated a significant improvement from baseline scores at 2 years postoperatively. There were no differences found between any patient-reported outcome at 2 years postoperatively. The presence of at least one self-reported drug allergy was not a significant risk factor for failing to achieve the MCID in any specific outcome measure. The presence of one or more drug allergy was not associated with worse patient-reported outcomes or lower rates of clinically significant outcome improvement after OCA.

Impact of Patient-Reported Allergies on Early Postoperative Opioid Use and Outcomes Following Ambulatory Hand Surgery.

Background: Patient-reported allergies (PRAs) are associated with suboptimal orthopaedic surgery outcomes and may serve as a proxy for mental health. While mental health disorders are known risk factors for increased opioid use, less is known about how PRAs impact opioid use after orthopedic surgery. The purpose of this study was to investigate the association between PRAs and postoperative opioid use, pain, and satisfaction following hand surgery. Methods: Patients who underwent ambulatory hand surgery at a single institution from May 2017 to March 2019 were retrospectively reviewed. Various scores, including the Mindfulness Attention Awareness Scale (MAAS), were collected preoperatively. Postoperatively, patients completed a 2-week pain diary, satisfaction, and visual analog scale (VAS) pain scores. Opioid consumption was converted to oral morphine equivalents (OMEs) using standard conversions. Results: A total of 137 patients were divided into 2 groups based on presence (≥1) (n = 73) or absence (0) (n = 64) of PRAs. At baseline, the ≥ 1 PRA group had significantly higher female composition (P < .001) and pain (P < .001) and lower PROMIS mental health scores (P = .044). Postoperative OME consumption averaged 42.5 (range 0-416) in the entire cohort, with no differences between groups. Among patients with ≥ 1 PRA, increasing number of allergies significantly correlated with increasing OME consumption across all time points (week 1, P = .016; week 2, P = .001; total, P = .005). Conclusions: The presence of PRAs did not impact postoperative narcotic usage, pain, or satisfaction. Increasing numbers of PRAs did, however, significantly correlate with higher narcotic use. These results may have implications for postoperative pain management in this population.

Impact of an Antibiotic Side-Chain-Based Cross-reactivity Chart Combined With Enhanced Allergy Assessment Processes for Surgical Prophylaxis Antimicrobials in Patients With β-Lactam Allergies.

β-Lactam antibiotics are first-line therapy for perioperative prophylaxis; however, patient-reported allergies often lead to increased prescribing of alternative antibiotics that may increase the incidence of surgical site infections. The R-group side chain of the β-lactam ring is responsible for allergic cross-reactivity and experts recommend the use of β-lactams that are structurally dissimilar. An internally developed, antibiotic side-chain-based cross-reactivity chart was developed and implemented alongside enhanced allergy assessment processes. This single-center, quasi-experimental study analyzed antibiotic prescribing in all adult patients with a documented β-lactam allergy undergoing an inpatient surgical procedure between quartile (Q) 1 (2012)-Q3 (2014) (historical group) and Q3 (2016)-Q3 (2018) (intervention group). Propensity-weighted scoring analyses compared categorical and continuous outcomes. Interrupted time-series analysis further analyzed key outcomes. A total of 1119 and 1089 patients were included in the historical and intervention cohorts, respectively. There was a significant difference in patients receiving a β-lactam alternative antibiotic between cohorts (84.9% vs 15.1%; P < .001). There was a decrease in 30-day readmissions in the intervention cohort (7.9% vs 6.3%; P = .035); however, there was no difference in the incidence of SSIs in patients readmitted (14.8% vs 13%; P = .765). No significant differences were observed in allergic reactions (0.5% vs 0.3%; P = .323), surgical site infections, in-hospital and 30-day mortality, healthcare facility-onset Clostridiodes difficile infection, acute kidney injury, or hospital costs. Implementation of an antibiotic cross-reactivity chart combined with enhanced allergy assessment processes significantly improved the prescribing of β-lactam antibiotics for surgical prophylaxis.

Hip arthroscopy for femoroacetabular impingement (FAI) patients with self-reported allergies: do multiple allergies have an effect on outcome?

AbstractMultiple self-reported allergies have been reported as a prognostic factor for outcome the following orthopedic procedures. This relationship has not yet been evaluated in a hip arthroscopy population. The purpose of this study is to identify associations between allergies and post-operative outcome scores in patients undergoing hip arthroscopy for femoroacetabular impingement (FAI). A retrospective review of surgically treated FAI patients at our institution was performed. Patient-reported allergies and 6-month and 1-year modified Harris Hip Scores (mHHS) were recorded. Bivariate analysis was performed evaluating association between allergies and post-operative mHHS. Multivariate regression was used to identify independent factors associated with post-operative mHHS while controlling for age, sex, BMI, psychiatric comorbidity, symptom duration, labral repair versus debridement, capsular management, chondral lesions and use of adjunct platelet rich plasma (PRP). Seventy patients were analysed. Average age was 30.7 years old (SD 8.96). A 52.9% were females. Twenty-six patients (37.1%) had reported allergies. At 6 months, bivariate analysis demonstrated no significant association between allergies and postop mHHS. This was true comparing patients with 0 versus 1 versus 2 versus 3 versus 5 allergies as separate groups (medians from 83.1 to 91.0, P = 0.60) as well as when combining patients with &gt;2 allergies into one group (0 versus 1 versus 2–5 allergies) (medians 84.7, 83.1, 86.0, respectively, P = 0.328). At 1 year, this lack of association was more pronounced (0 versus 1 versus 2 versus 3 versus 5: medians from 87.0 to 93.5, P = 0.9265 and 0 versus 1 versus 2–5: medians 93.5, 91.7, 89.0, respectively, P = 0.6450). Linear regression demonstrated preop mHHS and age were significantly associated with 1-year mHHS (logit mHHS rate = 0.026 ± 0.008 per unit, P = 0.0014 for preop mHHS and logit mHHS rate=−0.061 ± 0.018 per year, P = 0.0010 for age). After controlling for age and preop mHHS, allergies were not associated with postop mHHS. Allergies demonstrated no association with post-operative outcome following surgical treatment of FAI.

32. Does the number of patient-reported allergies impact clinical outcomes after lumbar spinal fusion?

BACKGROUND CONTEXT A gap in the literature exists regarding the association of clinical and radiographic outcomes with specific number of allergies for patients undergoing lumbar spinal fusions; which is necessary to close in order to better understand the prognostic value of patient-reported allergies. PURPOSE The purpose of this present study was therefore to determine the impact of specific number of allergies with clinic and radiographic outcomes following lumbar spinal fusion. STUDY DESIGN/SETTING Retrospective cohort analysis. PATIENT SAMPLE Analysis of patients who underwent an open posterior lumbar fusion from 2011 to 2017 was conducted. Surgery was indicated after failure of conservative treatment to address radiculopathy and/or neurogenic claudication. Patients were excluded if they were under 18 years of age at the time of surgery, presented with a lumbar vertebral body fracture, tumor, or infection, or underwent a fusion surgery that extended to the thoracic spine, high-grade spondylolisthesis, or concomitant deformity. OUTCOME MEASURES Patient-reported outcomes were recorded at preoperative and final clinic visits that included: Visual Analog Scale (VAS) Back/Leg pain, and Oswestry Disability Index (ODI). Achievement of minimal clinically important difference (MCID) was analyzed, along with rates of postoperative complication and reoperation. METHODS Preoperative and final patient-reported outcomes were obtained. Achievement of MCID was evaluated using following thresholds: ODI 14.9, VAS-back pain 2.1, VAS-leg pain 2.8. For analysis, patients were divided into two groups based on number of allergies: less than three allergies and greater than or equal to three allergies. RESULTS A total of 504 patients met inclusion criteria. There were 472 (93.65%) patients who reported fewer than three allergies, while 32 (6.35%) patients presented with three or more allergies. Patients with three or more reported allergies were more often older (p=0.026), female (p CONCLUSIONS Patients with more than three reported allergies have significantly less improvement of ODI scores from preoperative to final assessment and have significantly high ODI MCID scores postoperatively despite no significant difference in psychiatric condition or radiographic measurements between the two groups. These results suggest a lower perceived improvement of disability in patients with more than three reported allergies when compared with patients with a lower number of allergies. This study underscores the importance of considering the number of allergies as a prognostic factor, similar to psychiatric disorders. Furthermore, these findings can be used in discussion with patients regarding expectations of disability improvement prior to surgery. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Patient-Reported Allergies, a Marker of Preoperative Pain and Disability in Elective Spine Surgery.

Study Design:Retrospective review.Objective:Previous literature demonstrates mixed results regarding the relationship between patient-reported allergies and pain, function, and satisfaction scores. The objective of this study was to investigate the correlation between patient-reported allergies and preoperative Oswestry Disability Index (ODI), Neck Disability Index (NDI), and Patient-Reported Outcomes Measurement System (PROMIS) scores.Methods:All patients undergoing elective cervical, lumbar procedures between May 2017 and October 2018 were included. Baseline demographic information was recorded, as well as all reported allergies or adverse reactions. Preoperative PROMIS, ODI, and NDI scores were recorded. Hierarchical multiple linear regressions were used to assess the relationship between total number of allergies and the preoperative pain and function scores.Results:A total of 570 patients were included (476 lumbar, 94 cervical). The mean number of allergies reported was 1.89 ± 2.32. The mean preoperative ODI and NDI scores were 46.39 ± 17.67 and 43.47 ± 16.51, respectively. The mean preoperative PROMIS Physical Health and PROMIS Mental Health scores were 37.21 ± 6.54 and 43.89 ± 9.26, respectively. Hierarchical multiple linear regression showed that total number of reported allergies shared a statistically significant negative relationship with all of the following scores: ODI (B = 0.83, P = .02), NDI (B = 1.45, P = .02), PROMIS Physical Health (B = −0.29, P = .013), and PROMIS Mental Health (B = −0.38, P = .024).Conclusions:Patient-reported allergies share a statistically significant negative relationship with preoperative pain and function scores; as patients have increasing total number of allergies, the ODI/NDI scores become worse (increase) and the PROMIS scores become worse (decrease).

Socio-demographic factors impact time to discharge following total knee arthroplasty.

AIMTo determine social, logistical and demographic factors that influence time to discharge in a short stay pathway (SSP) by following total knee arthroplasty (TKA).METHODSThe study included primary TKA’s performed in a high-volume arthroplasty center from January 2016 through December 2016. Potential variables associated with increased hospital length of stay (LOS) were obtained from patient medical records. These included age, gender, race, zip code, body mass index (BMI), number of pre-operative medications used, number of narcotic medications used, number of patient reported allergies (PRA), simultaneous bilateral surgery, tobacco use, marital status, living arrangements, distance traveled for surgery, employment history, surgical day of the week, procedure end time and whether the surgery was performed during a major holiday week. Multivariate step-wise regression determined the impact of social, logistical and demographic factors on LOS.RESULTSEight hundred and six consecutive primary SSP TKA’s were included in this study. Patients were discharged at a median of 49 h (post-operative day two). The following factors increased LOS: Simultaneous bilateral TKA [46.1 h longer (P < 0.001)], female gender [4.3 h longer (P = 0.012)], age [3.5 h longer per ten-year increase in age (P < 0.001)], patient-reported allergies [1.1 h longer per allergy reported (P = 0.005)], later procedure end-times [0.8 h longer per hour increase in end-time (P = 0.004)] and Black or African American patients [6.1 h longer (P = 0.047)]. Decreased LOS was found in married patients [4.8 h shorter (P = 0.011)] and TKA’s performed during holiday weeks [9.4 h shorter (P = 0.011)]. Non-significant factors included: BMI, median income, patient’s living arrangement, smoking status, number of medications taken, use of pre-operative pain medications, distance traveled to hospital, and the day of surgery.CONCLUSIONThe cost of TKA is dependent upon LOS, which is affected by multiple factors. The clinical care team should acknowledge socio-demographic factors to optimize LOS.

Patient-reported Allergies are Associated With Preoperative Psychological Distress and Less Satisfying Patient Experience in a Lumbar Spine Surgery Population.

This was a retrospective cohort study. The main objectives of this study were: (1) to determine whether patient-reported allergies (PRAs) are associated with patient satisfaction scores, and (2) to clarify the association between PRAs and preoperative anxiety and depression in a lumbar spine surgery population. Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is currently used to measure the patient experience and there is concern that psychosocial factors are unaccounted for. Interestingly, PRAs have been linked to concurrent mood and other psychiatric disorders, as well as poor clinical outcomes in the orthopedic surgery setting. HCAHPS survey data, patient demographics, surgical characteristics, and preoperative health status were obtained for each patient. Allergies were categorized as medical (ie, medications) and environmental (ie, food, animals). Univariable and multivariable logistic regression models were used to determine whether the number of medical and environmental PRAs are associated with HCAHPS scores. In addition, multivariable logistic regression was used to analyze the association between PRAs and psychological distress. In 421 patients included, PRAs were associated with lower HCAHPS scores under several dimensions of the patient experience of care, including: nursing communication, pain management, communication about medicines, and transition of care. Medical PRAs was an independent predictor of low satisfaction with communication about a medication's side effects [odds ratio (OR), 0.88; P=0.03] and understanding the purpose for new medications (OR, 0.90; P=0.03). Environmental PRAs was an independent predictor of low satisfaction with both communication about a medication's side effects (OR, 0.68; P=0.03), and pain control (OR, 0.67; P=0.01). Moreover, having a PRA (OR, 1.64; P=0.04) was associated with EuroQol-5 Dimensions anxiety/depression and having an environmental PRA (OR, 2.13; P=0.03) was associated with depression. These findings highlight the potential utility of PRAs to help identify patients with psychological distress who are at risk for a poor experience of lumbar spine surgery.