Latest news with #DepartmentofAnesthesiology
Medscape
16-07-2025
- Health
- Medscape
New Data on Postoperative Delirium a ‘Call to Action'
Postoperative delirium following noncardiac surgery was linked to a 3.5-fold higher risk for death or major complications, but low-cost interventions focusing on avoiding patient disturbances can mitigate those negative outcomes, a new landmark study showed. An estimated one in 30 patients in the study experienced postoperative delirium, with high levels of variation in incidence rates among hospitals. Researchers said the findings are a 'call to action' to health providers to proactively manage the risks of postoperative delirium. 'This study is not just about identifying a problem, but it's also about giving people a sense of the scope of the problem. When you do that, it kind of energizes people to say okay, let's go out and see if we can do something about this,' principal investigator Laurent Glance, MD, professor and vice-chair for research in the Department of Anesthesiology at the University of Rochester School of Medicine (URMC), Rochester, New York, told Medscape Medical News . The study is the largest to date to examine the clinical implications of postoperative delirium on a national scale and was published online on July 8 in JAMA Network Open . Acute Brain Failure Postoperative delirium was once thought to be a minor and temporary complication. However, that has changed over the past decade. The American Geriatrics Society, which describes postoperative delirium as 'acute brain failure,' recommends the condition be treated as a medical emergency that requires rapid diagnosis and treatment. The cost of managing the condition runs roughly $26 billion to $42 billion in the US each year, and recent studies have linked postoperative delirium to the development of dementia in older adults. For this study, investigators used Medicare claims data from 2017 to 2020 of more than 5.5 million adults over the age of 65 years (mean age, 74.7; 57.2% women). Postoperative delirium was identified based on ICD-10 codes. Postoperative delirium was identified in 3.6% of cases. Patients with delirium were more likely to be male and have comorbidities, including cerebrovascular disease, heart failure, and dementia. Compared to patients without delirium, those with the condition were significantly more likely to experience death or major complications (adjusted odds ratio [aOR], 3.47), non-home discharges (aOR, 3.96) and 30-day mortality (aOR, 2.77; P < .001 for all). Findings were similar even after adjusting for hospital characteristics and excluded the patients admitted in 2020 during the height of the COVID-19 pandemic. 'Opportunity for Improvement' Investigators also found a nearly threefold variation in the rates of postoperative delirium among the 3169 hospitals included in the study. 'When you see that level of variation, what it tells you is that there is an opportunity for improvement,' Glance said. In fact, researchers noted that prior work found that postoperative delirium is preventable in up to 40% of cases. '[Postoperative delirium] is not something that's guaranteed because you're older or because you have multiple medical problems,' lead author Heather Lander, MD and assistant professor in the Department of Anesthesiology and Perioperative Medicine at URMC, Rochester, New York, told Medscape Medical News . 'This is something that we as a healthcare system can identify early,' she added. Variability among institutions could also be due to differences in coding accuracy and delirium screening, instead of reflecting true differences in hospital performance, the investigators wrote. Delirium Often Underreported The incidence of postoperative delirium reported in the study is markedly lower than previously reported rates of roughly 20% for noncardiac surgery patients. The researchers noted that incidence of postoperative delirium is known to be underreported in Medicare claims data. Postoperative delirium can be miscoded as other conditions for financial incentives or go undetected by clinicians, particularly for hypoactive delirium where patients may not show typical symptoms of restlessness or disorientation. Commenting on the finding for Medscape Medical News , Donna Fick, PhD, distinguished professor at Pennsylvania State University College of Nursing, University Park, Pennsylvania, noted that the miscoding of postoperative delirium might underrepresent affected patients in the study. 'When you use ICD-10 codes, claims or administrative data to examine this problem, you're dependent on clinicians coding the delirium, and we know that that's grossly under representative,' said Fick, who was not part of the study. Given the poor health outcomes identified and extrapolated onto a likely higher number of patients affected, this is a 'really important study' to represent delirium impacts on a national scale, Fick added. The authors also did a good job of controlling for important variables, including economic and social determinants of health as well as frailty and comorbidity, she said. Reducing Delirium Rates Investigators also found that patients undergoing surgery in hospitals with a higher rate of postoperative delirium had 1.5-fold higher odds of experiencing it compared to hospitals with lower rates. However, 'the inference from that finding has to be very carefully interpreted,' Esther Oh, MD, PhD, professor and associate director of the Johns Hopkins Memory and Alzheimer's Treatment Center, Baltimore, told Medscape Medical News. Some hospitals that are referral-based will take sicker patients compared to smaller hospitals, and those that have a delirium screening policy will find more delirium as a direct result, Oh noted. Both Oh and Fick supported several low-cost, nonpharmacologic interventions to reduce delirium risk that Glance and colleagues recommended in the study, including avoiding sleep disturbance, sensory support and enhanced screening for at-risk patients. 'It would be our hope eventually that postoperative delirium will be one of the quality metrics that will be used by CMS to evaluate hospital quality,' Glance said. In doing so, public reporting will enhance transparency, awareness and accountability of this issue and hospitals might up their efforts to reduce the rates of postoperative delirium, he added.
Medscape
15-05-2025
- Health
- Medscape
Multiple Naloxone Administrations Rise in EDs
TOPLINE: The proportion of emergency department (ED) patients requiring multiple naloxone administrations increased from 10.1% in 2016 to 17.4% in 2022 in the MarketScan database and from 3.0% in 2016 to 7.3% in 2022 in the National Emergency Department Sample (NEDS) database, indicating an increasing trend. METHODOLOGY: Researchers conducted a retrospective claims-based cohort study using data from the Merative MarketScan and NEDS databases in the United States between 2016 and 2022. The MarketScan data included 335,846 patients with ED claims for opioid overdose (mean age, 41 years), of whom 27,742 (mean age, 39 years) received naloxone during at least one ED encounter. The NEDS data encompassed 2,087,492 ED visits for opioid overdose (mean age, 46 years), with naloxone administered during 50,791 (mean age, 41 years) of these visits. The primary outcome in MarketScan was the percentage of patients who received multiple naloxone administrations during their first ED visit. The primary outcome in NEDS was the percentage of ED visits with multiple naloxone administrations, among ED visits in which naloxone was administered at least once. TAKEAWAY: Among patients from the MarketScan database who received naloxone, 14.7% received multiple administrations, increasing from 10.1% in 2016 to 17.4% in 2022 ꟷ a 72.8% increase (P < .01 for trend). Among NEDS ED visits during which naloxone was administered, multiple administrations were recorded during 6.3% of these visits, which increased by 146.7%, from 3.0% in 2016 to 7.3% in 2021 (P < .01 for trend). The likelihood of receiving multiple naloxone administrations in the ED increased by 10% (adjusted odds ratio [aOR], 1.10; 95% CI, 1.09-1.12) in MarketScan and 13% (aOR, 1.13; 95% CI, 1.11-1.16) in NEDS each year. The proportion of patients from MarketScan who received naloxone at their first ED visit increased by 60.5%, from 5.8% in 2016 to 9.3% in 2022, and NEDS ED visits with naloxone administration increased by 49.9%, from 1.9% to 2.9%. IN PRACTICE: "Increases in fatal and nonfatal opioid toxicities involving fentanyl have been accompanied by increased use of naloxone in the ED. While a single naloxone administration appears to address the needs of most ED patients, a small but growing percentage of ED patients require multiple naloxone administrations," the authors wrote. SOURCE: The study was led by Rachael Rzasa Lynn, MD, Department of Anesthesiology, University of Colorado School of Medicine, Aurora, Colorado. It was published online on May 8, 2025, in The Journal of Emergency Medicine. LIMITATIONS: Claims data did not include complete information on prehospital naloxone administration or the precise timing of administrations within the ED, making it difficult to distinguish between multiple administrations due to insufficient initial dosing and those due to extended opioid toxicity. Additionally, claims data lacked information on naloxone dose strengths or routes of administration or continuous intravenous infusion details. Additionally, the cross-sectional dataset may not have been fully representative of EDs across the United States. DISCLOSURES: The study was funded by Purdue Pharma. One author reported being a former employee of Genesis Research, which was paid by Purdue. Another author reported being an employee of Purdue. Some authors declared receiving grants or having other ties with various sources. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Daily Mail
30-04-2025
- Health
- Daily Mail
People who smoke weed 20 times more likely to die from colon cancer, says shock study
Smoking weed has been linked to colon cancer, one of the fastest-growing cancers, according to a shock new study. Consuming cannabis nearly every day increased the risk of dying from colon cancer by up to 20-fold, the research found. The findings challenge the long-held belief in some circles that cannabis can treat cancer - something scientists now say may be dangerously misleading. Researchers at the University of California San Diego tracked over 1,000 colon cancer patients and compared daily marijuana users to non-users. The difference was stark - people who used weed daily before their diagnosis had a 56 per cent chance of dying within five years of spotting the cancer. That was 11 times higher than those who never touched the drug. The outlook was even worse for patients who had an official cannabis addiction diagnosis. They were 24 times more likely to die than their peers within five years. The experts believe THC, the active ingredient in cannabis that causes hallucinogenic effects, may cause inflammation in the colon, which causes cancer cells to grow. THC may also block the production of disease-fighting T cells, which normally destroy cancer cells. Additionally, Cannabis use disorder (CUD) may lead to depression and anxiety, making patients less likely to commit to cancer treatments, the researchers said. However, just three per cent of participants had CUD, and it's unclear what stage their cancers were. The researchers said more studies are needed to understand how exactly cannabis addiction may increase the risk of colon cancer death. But the findings come at a critical time: cannabis use among young people has never been higher and a record number of youngsters are developing colon cancer. According to recent data from the National Survey on Drug Use and Health (NSDUH), 4.5 million young adults aged 18 to 25 in the U.S. reported using cannabis daily or nearly every day. And of them, eight in 10 daily users met the criteria for cannabis use disorder, indicating problematic patterns of use that can lead to health and social issues. Overall about 18million Americans of all ages use marijuana daily or nearly everyday. CUD is defined as using cannabis every day or nearly every day to the point where it negatively impacts a user's life, such as making it difficult to hold down a job. Dr Raphael Cuomo, associate professor in the Department of Anesthesiology at UC San Diego School of Medicine, said: 'This study adds to a growing body of evidence suggesting that heavy cannabis use may have underrecognized impacts on the immune system, mental health and treatment behaviors - all of which could influence cancer outcomes.' According to the latest data, early-onset colon cancer diagnoses in the U.S. are expected to rise by 90 per cent in people 20 to 34 years old between 2010 and 2030. In teens, rates have surged 500 per cent since the early 2000s. Cannabis use is also on the rise, largely due to recent decriminalization across the U.S. From 1992 to 2022, for example, daily and near-daily use has seen a 15-fold rise. The new study, published Monday in the Annals of Epidemiology, look at medical records from 1,088 colon cancer patients in the University of California Health system between 2012 and 2024. Of those, 34 were also diagnosed with CUD. The average age at colon cancer diagnosis was 59. On average, patients with CUD were diagnosed four months before learning they also had colon cancer. After accounting for other health factors like age, gender and disease severity, the researchers found the risk of dying within five years of diagnosis for patients with an active cannabis addiction was 56 per cent compared to five per cent in non users. Additionally, patients diagnosed with CUD before colon cancer had a 24-fold increased risk of death within five years of diagnosis. The researchers wrote: 'The results of this study indicate that a history of cannabis use disorder prior to colon cancer diagnosis is independently associated with an increased risk of mortality, even after adjusting for demographic and clinical confounders.' Dr Cuomo said further research is needed to understand the mechanisms of cannabis addiction and colorectal cancer. Indepedent researchers also emphasized the need for increased research but were also 'concerned' about the findings. Dr Rosario Ligresti, chief of gastroenterology at at Hackensack University Medical Center in New Jersey who was not involved in the research, said: 'This study raises serious concerns about the potential health risks associated with cannabis use. 'While further research is needed to fully understand the underlying mechanisms, these findings underscore the importance of educating the public about the potential dangers of marijuana, particularly in relation to colon cancer.' Dr Ligresti also agreed marijuana may suppress T cells, leading to colon cancer developments. Despite the findings, Dr Cuomo emphasized the findings don't mean cannabis users have to quit entirely. He sadi: 'This isn't about vilifying cannabis. It's about understanding the full range of its impacts, especially for people facing serious illnesses. 'We hope these findings encourage more research - and more nuanced conversations - about how cannabis interacts with cancer biology and care.'
Daily Mail
29-04-2025
- Health
- Daily Mail
Dirty habit millions admit to daily linked to 20x higher colon cancer death rate, says shock study
People who smoke weed are up to 20 times more likely to die from colon cancer, a shock study suggests. The study appears to blow the idea that cannabis can treat cancer - a myth that has prevailed in pro-weed circles for decades. Researchers in California looked through health records from more than 1,000 people - all of whom had colon cancer. They then compared cannabis users to non-users. They found colon cancer patients with a history of using cannabis every day or nearly every day had a 56 percent chance of dying within five years. This was an 11-fold difference compared to people who never used marijuana. And people formally diagnosed with cannabis use disorder - cannabis addiction - within months of being struck by colon cancer were 24 times more likely to die in five years compared to their peers. The experts, from the University of California San Diego, believe THC, the active ingredient in cannabis that causes hallucinogenic effects, may cause inflammation in the colon, which causes cancer cells to grow. THC may also block the production of disease-fighting T cells, which normally destroy cancer cells. Additionally, cannabis use disorder may lead to depression and anxiety, making patients less likely to commit to cancer treatments. However, just three percent of participants had cannabis use disorder, and it's unclear what stage their cancers were. The researchers said more studies are needed to understand how exactly cannabis addiction may increase the risk of colon cancer death. About 18million Americans use marijuana daily or nearly everyday, and about one in three are addicted to the substance. CUD is defined as using cannabis every day or nearly every day to the point where it negatively impacts a user's life, such as making it difficult to hold down a job. Dr Raphael Cuomo, associate professor in the Department of Anesthesiology at UC San Diego School of Medicine, said: 'This study adds to a growing body of evidence suggesting that heavy cannabis use may have underrecognized impacts on the immune system, mental health and treatment behaviors — all of which could influence cancer outcomes.' Though the findings seem surprising, they come from the same institution that published a groundbreaking study last week tying the colon cancer epidemic in young Americans to childhood exposure to the common bacteria E. coli. This would put nearly 100,000 Americans at risk. According to the latest data, early-onset colon cancer diagnoses in the US are expected to rise by 90 percent in people 20 to 34 years old between 2010 and 2030. In teens, rates have surged 500 percent since the early 2000s. Cannabis use is also on the rise, largely due to recent decriminalization across the US. From 1992 to 2022, for example, daily and near-daily use has seen a 15-fold rise. The new study, published Monday in the Annals of Epidemiology, look at medical records from 1,088 colon cancer patients in the University of California Health system between 2012 and 2024. Of those, 34 were also diagnosed with cannabis use disorder. The average age at colon cancer diagnosis was 59. On average, patients with CUD were diagnosed four months before learning they also had colon cancer. After accounting for other health factors like age, gender and disease severity, the researchers found the risk of dying within five years of diagnosis for patients with an active cannabis addiction was 56 percent compared to five percent in non users. Additionally, patients diagnosed with CUD before colon cancer had a 24-fold increased risk of death within five years of diagnosis. The researchers wrote: 'The results of this study indicate that a history of cannabis use disorder prior to colon cancer diagnosis is independently associated with an increased risk of mortality, even after adjusting for demographic and clinical confounders.' The experts are unsure exactly what caused the surge in mortality rate, but based on past research, they suggested THC could lead to harmful inflammation in the colon. This inflammation suppresses T cells, a type of white blood cell meant to kill cancer cells. Inflammation also damages colon tissue over time, causing cells to rapidly form to help repair the destruction. The faster cells form, the more likely they are to divide and mutate into cancer cells. Additionally, cannabis may lead to mental health consequences. Dr Cuomo said: 'High cannabis use is often associated with depression, anxiety and other challenges that may compromise a patient's ability to engage fully with cancer treatment.' The study directly contradicts some earlier research which has suggested some compounds in cannabis may inhibit cancer cell growth. A 2019 study from Penn State researchers of 370 synthetic cannabis compounds, for example, found 10 of them slowed the growth of seven forms of colon cancer. However, those researchers cautioned the mechanism behind this is unclear. Dr Cuomo said further research is needed to understand the mechanisms of cannabis addiction and colorectal cancer. He also emphasized the findings don't mean cannabis users have to quit entirely. He sadi: 'This isn't about vilifying cannabis. It's about understanding the full range of its impacts, especially for people facing serious illnesses. 'We hope these findings encourage more research — and more nuanced conversations — about how cannabis interacts with cancer biology and care.'
