Dataset Information

Evaluation of postoperative outcomes in patients following multi-level surgical reconstructions with the use Avive^™ soft tissue membrane on nerve after traumatic injury of the upper extremity and lower extremity.

ABSTRACT:

Background

Treatment of patients with traumatic axonotmesis presents challenges. Processed human umbilical cord membrane has been recently developed with improved handling and resorption time compared to other amniotic membrane wraps, and may be beneficial in nerve reconstruction. This study evaluates postoperative outcomes after traumatic peripheral nerve injury after placement of commercially available processed human umbilical cord membrane.

Methods

We performed a prospective, single-center pilot study of patients undergoing multi-level surgical reconstruction for exposed, non-transected peripheral nerve. Functional outcomes including pain, range of motion, pinch and grip strength, and the QuickDASH and SF-36 patient-reported outcome measures were recorded, when possible, at the 1-week and 3, 6, and 9 months postop visit. One-tailed paired t-tests were performed to evaluate outcome improvement at final follow-up.

Results

Twenty patients had processed human umbilical cord membrane placement without surgical complications. Mean follow-up was 7.5 months (range: 3-10 months) and mean age was 39 years (range: 15-65). Twelve (67%) patients were male, and the majority of placement sites were in the upper extremity (85%). Mean preoperative visual analog scale pain score was significantly reduced at most recent follow-up, as were QuickDASH scores. All patients had improved functional outcomes at the 9-month follow-up, and SF-36 outcomes at 9 months showed improvement across all dimensions.

Conclusion

This study indicates that processed human umbilical cord membrane may be a useful adjunct in nerve surgery with noted improvements in postoperative function, pain, and patient-reported outcome measures. Future studies are needed to assess long-term outcomes after traumatic nerve injury treated with processed human umbilical cord membrane.

SUBMITTER: Cox CT

PROVIDER: S-EPMC8188973 | biostudies-literature | 2021

REPOSITORIES: biostudies-literature

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Publications

Evaluation of postoperative outcomes in patients following multi-level surgical reconstructions with the use Avive<sup>™</sup> soft tissue membrane on nerve after traumatic injury of the upper extremity and lower extremity.

Cox Cameron T CT Suryavanshi Joash R JR Osemwengie Bradley O BO Rosqvist Sterling S Blue Matthew M McKee Desirae D MacKay Brendan J BJ

SAGE open medicine 20210606

<h4>Background</h4>Treatment of patients with traumatic axonotmesis presents challenges. Processed human umbilical cord membrane has been recently developed with improved handling and resorption time compared to other amniotic membrane wraps, and may be beneficial in nerve reconstruction. This study evaluates postoperative outcomes after traumatic peripheral nerve injury after placement of commercially available processed human umbilical cord membrane.<h4>Methods</h4>We performed a prospective, ...[more]

PMID: 34164128

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Project description:PurposeTo identify targets for corrective interventions and guide improved opioid stewardship, we studied opioid prescribing patterns of attending surgeons compared with surgical trainees for 2 upper-extremity surgeries: open reduction internal fixation (ORIF) of distal radius fractures (DRF), and carpal tunnel release (CTR).MethodsWe retrospectively reviewed records for all patients who underwent CTR or DRF ORIF at 6 hospitals across a large health system from 2016 to 2018. We collected prescriber training level (attending vs trainee), analgesic prescribed, and amount initially prescribed after surgery converted to oral morphine equivalents (OMEs). Regression models evaluated OMEs by prescriber and surgery type. Our final models included an interaction term between prescriber training level and year of surgery to assess group changes over time. No prescription guidelines or formal training was provided during the study period.ResultsWe included 707 CTR and 383 DRF ORIF patients. Opioids prescribed by trainees ranged from 90 to 300 OMEs (median, 180 OMEs). Opioids prescribed by attendings ranged from 100 to 225 OMEs (median, 150 OMEs). Early in the analyses, trainees prescribed significantly more than attendings (320 versus 180). Over time, trainees reduced overprescribing significantly more, by an additional 40 OME/y. By the end of the analysis period, trainees were prescribing less OME than were attendings (112.5 vs 150). Both groups continued to prescribe more than recently suggested amounts for both procedures.ConclusionsOur study found that both attendings and trainees overprescribed opioids after surgery. Trainees prescribed more than attendings over the study period; however, when analyzing for improvement over time and with no formal intervention or training, trainees showed greater improvement, eventually dropping to levels at or below that of attendings. Considering that most change was seen at the trainee level, education for established providers may be an area in which more improvement can be made.Clinical relevanceUnderstanding which providers are more likely to overprescribe opioids can help guide interventions that improve opioid stewardship.

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Dataset Information

Evaluation of postoperative outcomes in patients following multi-level surgical reconstructions with the use Avive^™ soft tissue membrane on nerve after traumatic injury of the upper extremity and lower extremity.

Background

Methods

Results

Conclusion

Publications

Evaluation of postoperative outcomes in patients following multi-level surgical reconstructions with the use Avive<sup>™</sup> soft tissue membrane on nerve after traumatic injury of the upper extremity and lower extremity.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets

Dataset Information

Evaluation of postoperative outcomes in patients following multi-level surgical reconstructions with the use Avive™ soft tissue membrane on nerve after traumatic injury of the upper extremity and lower extremity.

Background

Methods

Results

Conclusion

Publications

Evaluation of postoperative outcomes in patients following multi-level surgical reconstructions with the use Avive<sup>™</sup> soft tissue membrane on nerve after traumatic injury of the upper extremity and lower extremity.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets

Evaluation of postoperative outcomes in patients following multi-level surgical reconstructions with the use Avive^™ soft tissue membrane on nerve after traumatic injury of the upper extremity and lower extremity.