Fluoroquinolone use tied to higher risk of aortic dissection and aneurysm
A meta-analysis of two observational studies found that current fluoroquinolone use was associated with modestly higher risk of aortic dissection (OR 2.79, 95% CI 2.31-3.37) and aortic aneurysm (OR 2.25, 95% CI 2.03-2.49).
Citation: Singh S, Nautiyal A. Aortic dissection and aortic aneurysms associated with fluoroquinolones: A systematic review and meta-analysis. Am J Med [online ahead of print, July 21, 2017].
Optimal lengths of postoperative opioid prescription range from 4 to 15 days
A multicenter review of opioid prescriptions after common surgical procedures found that the median prescription lengths were between 4 and 6 days for general surgery procedures, women’s health procedures, and musculoskeletal procedures. The prescription lengths associated with lowest requirement for refill were 9 days for general surgery, 13 days for women’s health, and 15 days for musculoskeletal procedures. Study authors recommend considering this information when determining the optimal opioid prescription duration for postoperative discharges.
Citation: Scully RE, Schoenfeld AJ, Jiang W, et al. Defining optimal length of opioid pain medication prescription after common surgical procedures. JAMA Surg. Sept 2017.
Increased mortality in weekend and holiday hospital admissions
A meta-analysis of 97 studies showed a greater relative risk of mortality for patients admitted during the weekend or holidays compared to those admitted during the week. Subgroup analyses did not reveal significant effect modification by staffing level and other hospital factors. Further research to identify contributing factors and potential interventions is needed.
Citation: Pauls LA, Johnson-Paben R, McGready J, Murphy JD, Pronovost PJ, Wu CL. The weekend effect in hospitalized patients: a meta-analysis. J Hosp Med. 2017;12(9):760-6.
Kayexalate should not be taken at the same time as other medications
The Food and Drug Administration has released a drug safety communication on kayexalate (sodium polystyrene sulfonate). Given recent research showing that kayexalate may decrease the absorption and effectiveness of many oral medications, the FDA recommended that when prescribing kayexalate, it should be given at least 3 hours before or after administration of other oral medications. This time should be increased to 6 hours for those with conditions that result in delayed gastric emptying.
Citation: Food and Drug Administration. Kayexalate (sodium polystyrene sulfonate): Drug Safety Communication. 09/06/2017.
Most thrombophilia testing done in the hospital does not add value
A retrospective cohort study among emergency department and hospitalized patients at an academic medical center examined 163 patients and 1,451 thrombophilia tests; 63% of tests were of “minimal clinical utility.”
Citation: Cox N, Johnson SA, Vazquez S, et al. Patterns and appropriateness of thrombophilia testing in an academic medical center. J Hosp Med. 2017;12(9):705-709.