Dexur & researchers from top institutions such as Harvard Medical School collaborate to publish several research papers based on Real World…

Dexur & researchers from top institutions such as Harvard Medical School collaborate to publish several research papers based on Real World Evidence (RWE)

Dexur & researchers from top institutions such as Harvard Medical School collaborate to publish several Real-World Evidence (RWE) based research papers in peer-reviewed publications. A listing of these papers is given below.

Paper Title: Opioid-Related Adverse Events: Incidence and Impact in Patients Undergoing Cardiac Surgery

Publication Journal: American Journal of Medical Quality

Publication Date: Nov 27, 2019

Institutions:

Authors: Allen KB, Brovman EY, Chhatriwalla AK, Greco KJ, Rao N, Kumar A, Urman RD

Abstract:

Purpose. Opioid-related adverse drug events (ORADEs) increase patient length of stay (LOS) and health care costs. However, ORADE rates may be underreported. This study attempts to understand the degree to which ORADEs are underreported in Medicare patients undergoing cardiac surgery.

Materials and Methods. The Center for Medicare and Medicaid Services administrative claims database was used to identify ORADEs in 110158 Medicare beneficiaries who underwent cardiac valve (n = 50525) or coronary bypass (n = 59633) surgery between April 2016 and March 2017. The International Classification of Disease (ICD)-10 codes specifically linked to ORADEs were used to identify an actual ORADE rate, while additional ICD codes, clinically associated with butas not specific to adverse drug events were analyzed as potential ORADEs. Length of stay (LOS) and hospital daily revenue were analyzed among patients with or without a potential ORADE.

Results. Among patients undergoing valve or bypass surgery, the documented ORADE rate was 0.7% (743/110158). However, potential ORADEs may have occurred in up to 32.4% (35658/110158) of patients. In patients with a potential ORADE, mean LOS was longer (11.4 vs 8.2 days; P < .0001) and mean Medicare revenue/day was lower ($4016 vs $4412; P < .0001). The mean net difference in revenue/day between patients with and without an ORADE varied between $231 and $1145, depending on the Diagnosis-Related Group analyzed.

Conclusions. ORADEs are likely underreported following cardiac surgery. ORADEs can be associated with increased LOS and decreased hospital revenue. Understanding the incidence and economic impact of ORADEs may expedite changes to postoperative pain management. Adopting multimodal pain management strategies that reduce exposure to opioids may improve outcomes by reducing complications, side effects, and health care costs.

Paper Title: The Association Between Potential Opioid-Related Adverse Drug Events and Outcomes in Colorectal Surgery

Publication Journal: Journal of Laparoendoscopic & Advanced Surgical Techniques

Publication Date: Nov 08, 2019

Institutions:

Authors: Homsi J, Brovman EY, Rao N, Whang EE, Urman RD

Abstract:

INTRODUCTION:Major colorectal surgery procedures are complex operations that can result in significant postoperative pain and complications. More evidence is needed to demonstrate how opioid-related adverse drug events (ORADEs) after colorectal surgery can affect hospital length of stay (LOS), hospital revenue, and what their association is with clinical conditions. By understanding the clinical and economic impact of potential ORADEs within colorectal surgery, we hope to further guide approaches to perioperative pain management in an effort to improve patient care and reduce hospital costs.

MATERIALS AND METHODS:We conducted a retrospective study utilizing the Centers for Medicare and Medicaid Services (CMS) Administrative Database to analyze Medicare discharges involving three colorectal surgery diagnosis-related groups (DRGs) to identify potential ORADEs. The impact of potential ORADEs on mean hospital LOS and hospital revenue was analyzed.

RESULTS:The potential ORADE rate in patients undergoing colorectal surgery was 23.92%. The mean LOS for discharges with a potential ORADE was 5.35 days longer than without an ORADE. The mean hospital revenue per day with a potential ORADE was $418 less than without an ORADE. Any type of open surgery had a statistically significant higher potential ORADE rate than the matched laparoscopic case (P<.001). Clinical conditions most strongly associated with ORADEs in colorectal surgery included septicemia, pneumonia, shock, and fluid and electrolyte disorders.

CONCLUSION:The incidence of ORADEs in colorectal surgery is high and is associated with longer hospital stays and reduced hospital revenue. Reducing the use of opioids in the perioperative setting, such as using multimodal analgesia strategies, may lead to positive outcomes with shorter hospital stays, increased hospital revenue, and improved patient care.

Paper Title: The Association Between Potential Opioid-Related Adverse Drug Events and Outcomes in Total Knee Arthroplasty: A Retrospective Study

Publication Journal: Advances in Therapy

Publication Date: Oct 29, 2019

Institutions:

Authors: Jones MR, Kramer ME, Beutler SS, Kaye AD, Rao N, Brovman EY, Urman RD

Abstract:

INTRODUCTION: Characterization of the clinical and economic impact of opioid-related adverse drug events (ORADEs) after total knee arthroplasty (TKA) may guide provider and hospital system approach to managing postoperative pain after TKA. Our analysis quantifies the rate of potential ORADEs after TKA, the impact of potential ORADEs on length of stay (LOS) and hospital revenue, as well as their association with specific patient risk factors and comorbid clinical conditions.

METHODS: We conducted a retrospective study using the Centers for Medicare and Medicaid Services administrative database to analyze Medicare discharges involving two knee replacement surgery diagnosis-related groups (DRGs) in order to identify potential ORADEs. The impact of potential ORADEs on mean hospital LOS and hospital revenue was analyzed.

RESULTS: The potential ORADE rate in patients who underwent TKA was 25,523 out of 316,858 records analyzed (8.0%). The mean LOS for patients who experienced a potential ORADE was 1.04 days longer than those without an ORADE. The mean hospital revenue per day with a potential ORADE was $1334 (USD) less than without an ORADE. Potential ORADEs were significantly associated with poor patient outcomes such as pneumonia, septicemia, and shock.

CONCLUSION: Potential ORADEs in TKA are associated with longer hospitalizations, decreased hospital revenue, and poor patient outcomes. Certain risk factors may predispose patients to experiencing an ORADE, and thus perioperative pain management strategies that reduce the frequency of ORADEs particularly in at-risk patients can improve patient satisfaction and increase hospital revenue following TKAs.

Paper Title: Potential opioid-related adverse events following spine surgery in elderly patients

Publication Journal: Clinical Neurology and Neurosurgery

Publication Date: Oct 03, 2019

Institutions:

Authors:Jones MR, Brovman EY, Novitch MB, Rao N, Urman RD

Abstract:

OBJECTIVE: Understanding the clinical and economic impact of opioid-related adverse drug events (ORADEs) within spine surgery may guide both the clinician's and hospital administration's approach to treating perioperative pain, thus improving patient care and reducing hospital costs. The objective of this analysis is to understand how potential ORADEs after spine surgery in elderly patients affect length of stay, hospital revenue and their association with comorbid conditions.

PATIENTS AND METHODS: We conducted a retrospective study utilizing the Center for Medicare/Medicaid Services Administrative Database to analyze Medicare discharges between April 2016 and March 2017 involving 14 spine surgery DRGs for major spine procedures in order to identify potential ORADEs. An analysis was conducted using this database to identify the incidence of potential ORADEs as well as their impact on mean hospital length of stay and hospital revenue.

RESULTS: There were 177,432 discharges during the study period. The ORADE rate in patients undergoing spine surgery was 13.9% (24,642/177,432). The mean length of stay (LOS) for discharges with an ORADE was 3.13 days longer than without an ORADE (6.29 days with an ORADE vs 3.16 days without an ORADE). The adverse post-operative outcomes most strongly associated with potential ORADEs included shock, pneumonia, and septicemia. The mean hospital revenue per day with an ORADE was $3,076 less than without an ORADE ($7,263 with an ORADE vs $10,339 without an ORADE).

CONCLUSION: Potential ORADEs in spine surgery in elderly patients are common and are associated with longer hospitalizations and decreased hospital revenue. Perioperative pain management strategies that reduce ORADEs may improve patient care and increase hospital revenue.

Paper Title: A Dashboard for Monitoring Opioid-Related Adverse Drug Events Following Surgery Using a National Administrative Database

Publication Journal: American Journal of Medical Quality

Publication Date: June 25, 2019

Institutions:

Authors: Stone AB, Jones MR, Rao N, Urman RD

Abstract:

Opioid-related adverse drug events (ORADEs) include a range of complications, from respiratory arrest to ileus and urinary retention. ORADEs correlate to morbidity, mortality, and increased costs. The Centers for Medicare & Medicaid Services database, which represents approximately 35% of hospital discharges. The authors searched for previously published ICD-9 codes that defined ORADEs. A group of surgical diagnosis-related groups (DRGs) were selected. Recurring queries were programmed using these ICD codes and DRGs and used to update an online dashboard. The dashboard presents an estimate of the burden of ORADEs to frontline clinicians and hospital leadership and allows users to compare local data on ORADEs rates to other hospitals. Users are able to refine their search by surgery type or ORADE type. An interface was created, using national administrative claims data, to allow hospitals to access their ORADEs and benchmark local data against national trends.

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Dexur & researchers from top institutions such as Harvard Medical School collaborate to publish several research papers based on Real World...