Pain, Analgesic Use, and Patient Satisfaction With Spinal Versus General Anesthesia for Hip Fracture Surgery : A Randomized Clinical Trial
Neuman, Mark D; Feng, Rui; Ellenberg, Susan S; Sieber, Frederick; Sessler, Daniel I; Magaziner, Jay; Elkassabany, Nabil; Schwenk, Eric S; Dillane, Derek; Marcantonio, Edward R; Menio, Diane; Ayad, Sabry; Hassan, Manal; Stone, Trevor; Papp, Steven; Donegan, Derek; Marshall, Mitchell; Jaffe, J Douglas; Luke, Charles; Sharma, Balram; Azim, Syed; Hymes, Robert; Chin, Ki-Jinn; Sheppard, Richard; Perlman, Barry; Sappenfield, Joshua; Hauck, Ellen; Hoeft, Mark A; Tierney, Ann; Gaskins, Lakisha J; Horan, Annamarie D; Brown, Trina; Dattilo, James; Carson, Jeffrey L; Looke, Thomas; Bent, Sandra; Franco-Mora, Ariana; Hedrick, Pamela; Newbern, Matthew; Tadros, Rafik; Pealer, Karen; Vlassakov, Kamen; Buckley, Carolyn; Gavin, Lauren; Gorbatov, Svetlana; Gosnell, James; Steen, Talora; Vafai, Avery; Zeballos, Jose; Hruslinski, Jennifer; Cardenas, Louis; Berry, Ashley; Getchell, John; Quercetti, Nicholas; Bajracharya, Gauasan; Billow, Damien; Bloomfield, Michael; Cuko, Evis; Elyaderani, Mehrun K; Hampton, Robert; Honar, Hooman; Khoshknabi, Dilara; Kim, Daniel; Krahe, David; Lew, Michael M; Maheshwer, Conjeevram B; Niazi, Azfar; Saha, Partha; Salih, Ahmed; de Swart, Robert J; Volio, Andrew; Bolkus, Kelly; DeAngelis, Matthew; Dodson, Gregory; Gerritsen, Jeffrey; McEniry, Brian; Mitrev, Ludmil; Kwofie, M Kwesi; Belliveau, Anne; Bonazza, Flynn; Lloyd, Vera; Panek, Izabela; Dabiri, Jared; Chavez, Chris; Craig, Jason; Davidson, Todd; Dietrichs, Chad; Fleetwood, Cheryl; Foley, Mike; Getto, Chris; Hailes, Susie; Hermes, Sarah; Hooper, Andy; Koener, Greg; Kohls, Kate; Law, Leslie; Lipp, Adam; Losey, Allison; Nelson, William; Nieto, Mario; Rogers, Pam; Rutman, Steve; Scales, Garrett; Sebastian, Barbara; Stanciu, Tom; Lobel, Gregg; Giampiccolo, Michelle; Herman, Dara; Kaufman, Margit; Murphy, Bryan; Pau, Clara; Puzio, Thomas; Veselsky, Marlene; Apostle, Kelly; Boyer, Dory; Fan, Brenda Chen; Lee, Susan; Lemke, Mike; Merchant, Richard; Moola, Farhad; Payne, Kyrsten; Perey, Bertrand; Viskontas, Darius; Poler, Mark; D'Antonio, Patricia; O'Neill, Greg; Abdullah, Amer; Fish-Fuhrmann, Jamie; Giska, Mark; Fidkowski, Christina; Guthrie, Stuart Trent; Hakeos, William; Hayes, Lillian; Hoegler, Joseph; Nowak, Katherine; Beck, Jeffery; Cuff, Jaslynn; Gaski, Greg; Haaser, Sharon; Holzman, Michael; Malekzadeh, A Stephen; Ramsey, Lolita; Schulman, Jeff; Schwartzbach, Cary; Azefor, Tangwan; Davani, Arman; Jaberi, Mahmood; Masear, Courtney; Haider, Syed Basit; Chungu, Carolyn; Ebrahimi, Ali; Fikry, Karim; Marcantonio, Andrew; Shelvan, Anitha; Sanders, David; Clarke, Collin; Lawendy, Abdel; Schwartz, Gary; Garg, Mohit; Kim, Joseph; Caruci, Juan; Commeh, Ekow; Cuevas, Randy; Cuff, Germaine; Franco, Lola; Furgiuele, David; Giuca, Matthew; Allman, Melissa; Barzideh, Omid; Cossaro, James; D'Arduini, Armando; Farhi, Anita; Gould, Jason; Kafel, John; Patel, Anuj; Peller, Abraham; Reshef, Hadas; Safur, Mohammed; Toscano, Fiore; Tedore, Tiffany; Akerman, Michael; Brumberger, Eric; Clark, Sunday; Friedlander, Rachel; Jegarl, Anita; Lane, Joseph; Lyden, John P; Mehta, Nili; Murrell, Matthew T; Painter, Nathan; Ricci, William; Sbrollini, Kaitlyn; Sharma, Rahul; Steel, Peter A D; Steinkamp, Michele; Weinberg, Roniel; Wellman, David Stephenson; Nader, Antoun; Fitzgerald, Paul; Ritz, Michaela; Bryson, Greg; Craig, Alexandra; Farhat, Cassandra; Gammon, Braden; Gofton, Wade; Harris, Nicole; Lalonde, Karl; Liew, Allan; Meulenkamp, Bradley; Sonnenburg, Kendra; Wai, Eugene; Wilkin, Geoffrey; Troxell, Karen; Alderfer, Mary Ellen; Brannen, Jason; Cupitt, Christopher; Gerhart, Stacy; McLin, Renee; Sheidy, Julie; Yurick, Katherine; Chen, Fei; Dragert, Karen; Kiss, Geza; Malveaux, Halina; McCloskey, Deborah; Mellender, Scott; Mungekar, Sagar S; Noveck, Helaine; Sagebien, Carlos; Biby, Luat; McKelvy, Gail; Richards, Anna; Abola, Ramon; Ayala, Brittney; Halper, Darcy; Mavarez, Ana; Rizwan, Sabeen; Choi, Stephen; Awad, Imad; Flynn, Brendan; Henry, Patrick; Jenkinson, Richard; Kaustov, Lilia; Lappin, Elizabeth; McHardy, Paul; Singh, Amara; Donnelly, Joanne; Gonzalez, Meera; Haydel, Christopher; Livelsberger, Jon; Pazionis, Theresa; Slattery, Bridget; Vazquez-Trejo, Maritza; Baratta, Jaime; Cirullo, Michael; Deiling, Brittany; Deschamps, Laura; Glick, Michael; Katz, Daniel; Krieg, James; Lessin, Jennifer; Mojica, Jeffrey; Torjman, Marc; Jin, Rongyu; Salpeter, Mary Jane; Powell, Mark; Simmons, Jeffrey; Lawson, Prentiss; Kukreja, Promil; Graves, Shanna; Sturdivant, Adam; Bryant, Ayesha; Crump, Sandra Joyce; Verrier, Michelle; Green, James; Menon, Matthew; Applegate, Richard; Arias, Ana; Pineiro, Natasha; Uppington, Jeffrey; Wolinsky, Phillip; Gunnett, Amy; Hagen, Jennifer; Harris, Sara; Hollen, Kevin; Holloway, Brian; Horodyski, Mary Beth; Pogue, Trevor; Ramani, Ramachandran; Smith, Cameron; Woods, Anna; Warrick, Matthew; Flynn, Kelly; Mongan, Paul; Ranganath, Yatish; Fernholz, Sean; Ingersoll-Weng, Esperanza; Marian, Anil; Seering, Melinda; Sibenaller, Zita; Stout, Lori; Wagner, Allison; Walter, Alicia; Wong, Cynthia; Orwig, Denise; Goud, Maithri; Helker, Chris; Mezenghie, Lydia; Montgomery, Brittany; Preston, Peter; Schwartz, J Sanford; Weber, Ramona; Fleisher, Lee A; Mehta, Samir; Stephens-Shields, Alisa J; Dinh, Cassandra; Chelly, Jacques E; Goel, Shiv; Goncz, Wende; Kawabe, Touichi; Khetarpal, Sharad; Monroe, Amy; Shick, Vladislav; Breidenstein, Max; Dominick, Timothy; Friend, Alexander; Mathews, Donald; Lennertz, Richard; Sanders, Robert; Akere, Helen; Balweg, Tyler; Bo, Amber; Doro, Christopher; Goodspeed, David; Lang, Gerald; Parker, Maggie; Rettammel, Amy; Roth, Mary; White, Marissa; Whiting, Paul; Allen, Brian F S; Baker, Tracie; Craven, Debra; McEvoy, Matt; Turnbo, Teresa; Kates, Stephen; Morgan, Melanie; Willoughby, Teresa; Weigel, Wade; Auyong, David; Fox, Ellie; Welsh, Tina; Cusson, Bruce; Dobson, Sean; Edwards, Christopher; Harris, Lynette; Henshaw, Daryl; Johnson, Kathleen; McKinney, Glen; Miller, Scott; Reynolds, Jon; Segal, B Scott; Turner, Jimmy; VanEenenaam, David; Weller, Robert; Lei, Jineli; Treggiari, Miriam; Akhtar, Shamsuddin; Blessing, Marcelle; Johnson, Chanel; Kampp, Michael; Kunze, Kimberly; O'Connor, Mary; Looke, Thomas; Tadros, Rafik; Vlassakov, Kamen; Cardenas, Louis; Bolkus, Kelly; Mitrev, Ludmil; Kwofie, M Kwesi; Dabiri, Jared; Lobel, Gregg; Poler, Mark; Giska, Mark; Sanders, David; Schwartz, Gary; Giuca, Matthew; Tedore, Tiffany; Nader, Antoun; Bryson, Greg; Troxell, Karen; Kiss, Geza; Choi, Stephen; Powell, Mark; Applegate, Richard; Warrick, Matthew; Ranganath, Yatish; Chelly, Jacques E; Lennertz, Richard; Sanders, Robert; Allen, Brian F S; Kates, Stephen; Weigel, Wade; Li, Jinlei; Wijeysundera, Duminda N; Kheterpal, Sachin; Moore, Reneé H; Smith, Alexander K; Tosi, Laura L; Looke, Thomas; Mehta, Samir; Fleisher, Lee; Hruslinski, Jennifer; Ramsey, Lolita; Langlois, Christine; Mezenghie, Lydia; Montgomery, Brittany; Oduwole, Samuel; Rose, Thomas
BACKGROUND:The REGAIN (Regional versus General Anesthesia for Promoting Independence after Hip Fracture) trial found similar ambulation and survival at 60 days with spinal versus general anesthesia for hip fracture surgery. Trial outcomes evaluating pain, prescription analgesic use, and patient satisfaction have not yet been reported. OBJECTIVE:To compare pain, analgesic use, and satisfaction after hip fracture surgery with spinal versus general anesthesia. DESIGN:Preplanned secondary analysis of a pragmatic randomized trial. (ClinicalTrials.gov: NCT02507505). SETTING:46 U.S. and Canadian hospitals. PARTICIPANTS:Patients aged 50 years or older undergoing hip fracture surgery. INTERVENTION:Spinal or general anesthesia. MEASUREMENTS:Pain on postoperative days 1 through 3; 60-, 180-, and 365-day pain and prescription analgesic use; and satisfaction with care. RESULTS:A total of 1600 patients were enrolled. The average age was 78 years, and 77% were women. A total of 73.5% (1050 of 1428) of patients reported severe pain during the first 24 hours after surgery. Worst pain over the first 24 hours after surgery was greater with spinal anesthesia (rated from 0 [no pain] to 10 [worst pain imaginable]; mean difference, 0.40 [95% CI, 0.12 to 0.68]). Pain did not differ across groups at other time points. Prescription analgesic use at 60 days occurred in 25% (141 of 563) and 18.8% (108 of 574) of patients assigned to spinal and general anesthesia, respectively (relative risk, 1.33 [CI, 1.06 to 1.65]). Satisfaction was similar across groups. LIMITATION:Missing outcome data and multiple outcomes assessed. CONCLUSION:Severe pain is common after hip fracture. Spinal anesthesia was associated with more pain in the first 24 hours after surgery and more prescription analgesic use at 60 days compared with general anesthesia. PRIMARY FUNDING SOURCE:
PMID: 35696684
ISSN: 1539-3704
CID: 5277802
Burden of Neurological Disorders Across the US From 1990-2017: A Global Burden of Disease Study
,; Feigin, Valery L; Vos, Theo; Alahdab, Fares; Amit, Arianna Maever L; Bärnighausen, Till Winfried; Beghi, Ettore; Beheshti, Mahya; Chavan, Prachi P; Criqui, Michael H; Desai, Rupak; Dhamminda Dharmaratne, Samath; Dorsey, E Ray; Wilder Eagan, Arielle; Elgendy, Islam Y; Filip, Irina; Giampaoli, Simona; Giussani, Giorgia; Hafezi-Nejad, Nima; Hole, Michael K; Ikeda, Takayoshi; Owens Johnson, Catherine; Kalani, Rizwan; Khatab, Khaled; Khubchandani, Jagdish; Kim, Daniel; Koroshetz, Walter J; Krishnamoorthy, Vijay; Krishnamurthi, Rita V; Liu, Xuefeng; Lo, Warren David; Logroscino, Giancarlo; Mensah, George A; Miller, Ted R; Mohammed, Salahuddin; Mokdad, Ali H; Moradi-Lakeh, Maziar; Morrison, Shane Douglas; Shivamurthy, Veeresh Kumar N; Naghavi, Mohsen; Nichols, Emma; Norrving, Bo; Odell, Christopher M; Pupillo, Elisabetta; Radfar, Amir; Roth, Gregory A; Shafieesabet, Azadeh; Sheikh, Aziz; Sheikhbahaei, Sara; Shin, Jae Il; Singh, Jasvinder A; Steiner, Timothy J; Stovner, Lars Jacob; Wallin, Mitchell Taylor; Weiss, Jordan; Wu, Chenkai; Zunt, Joseph Raymond; Adelson, Jaimie D; Murray, Christopher J L
IMPORTANCE:Accurate and up-to-date estimates on incidence, prevalence, mortality, and disability-adjusted life-years (burden) of neurological disorders are the backbone of evidence-based health care planning and resource allocation for these disorders. It appears that no such estimates have been reported at the state level for the US. OBJECTIVE:To present burden estimates of major neurological disorders in the US states by age and sex from 1990 to 2017. DESIGN, SETTING, AND PARTICIPANTS:This is a systematic analysis of the Global Burden of Disease (GBD) 2017 study. Data on incidence, prevalence, mortality, and disability-adjusted life-years (DALYs) of major neurological disorders were derived from the GBD 2017 study of the 48 contiguous US states, Alaska, and Hawaii. Fourteen major neurological disorders were analyzed: stroke, Alzheimer disease and other dementias, Parkinson disease, epilepsy, multiple sclerosis, motor neuron disease, migraine, tension-type headache, traumatic brain injury, spinal cord injuries, brain and other nervous system cancers, meningitis, encephalitis, and tetanus. EXPOSURES:Any of the 14 listed neurological diseases. MAIN OUTCOME AND MEASURE:Absolute numbers in detail by age and sex and age-standardized rates (with 95% uncertainty intervals) were calculated. RESULTS:The 3 most burdensome neurological disorders in the US in terms of absolute number of DALYs were stroke (3.58 [95% uncertainty interval [UI], 3.25-3.92] million DALYs), Alzheimer disease and other dementias (2.55 [95% UI, 2.43-2.68] million DALYs), and migraine (2.40 [95% UI, 1.53-3.44] million DALYs). The burden of almost all neurological disorders (in terms of absolute number of incident, prevalent, and fatal cases, as well as DALYs) increased from 1990 to 2017, largely because of the aging of the population. Exceptions for this trend included traumatic brain injury incidence (-29.1% [95% UI, -32.4% to -25.8%]); spinal cord injury prevalence (-38.5% [95% UI, -43.1% to -34.0%]); meningitis prevalence (-44.8% [95% UI, -47.3% to -42.3%]), deaths (-64.4% [95% UI, -67.7% to -50.3%]), and DALYs (-66.9% [95% UI, -70.1% to -55.9%]); and encephalitis DALYs (-25.8% [95% UI, -30.7% to -5.8%]). The different metrics of age-standardized rates varied between the US states from a 1.2-fold difference for tension-type headache to 7.5-fold for tetanus; southeastern states and Arkansas had a relatively higher burden for stroke, while northern states had a relatively higher burden of multiple sclerosis and eastern states had higher rates of Parkinson disease, idiopathic epilepsy, migraine and tension-type headache, and meningitis, encephalitis, and tetanus. CONCLUSIONS AND RELEVANCE:There is a large and increasing burden of noncommunicable neurological disorders in the US, with up to a 5-fold variation in the burden of and trends in particular neurological disorders across the US states. The information reported in this article can be used by health care professionals and policy makers at the national and state levels to advance their health care planning and resource allocation to prevent and reduce the burden of neurological disorders.
PMCID:7607495
PMID: 33136137
ISSN: 2168-6157
CID: 5704682