BACKGROUND: The United States is in the middle of an opioid epidemic. Gastrointestinal surgery has been ranked in the top 3 surgical subspecialties for highest opioid prescribing. OBJECTIVE: The goal of this study is to determine the rate of and risk factors for prolonged opioid use following colectomy. DESIGN: This study utilized data (2015–2017) from the American College of Surgeons National Surgical Quality Improvement Program from 5 institutions. SETTINGS: This study was conducted at 2 academic and 3 community hospitals. PATIENTS: Included were 1243 patients who underwent colectomy. MAIN OUTCOME MEASURES: The primary outcome was rate of prolonged opioid use defined as a new opioid prescription 90 to 180 days postoperatively. RESULTS: A total of 132 (10.6%) patients were prolonged opioid users. In univariate analysis, patients who were prolonged opioid users were significantly more likely to have had more than one opioid prescription in the prior year, to have a higher ASA classification, to undergo an open procedure, to have an ostomy created, and to be discharged with a high quantity of opioids (all p < 0.05). Prolonged opioid users were significantly more likely to have a complication (p = 0.007) or readmission (p = 0.003) within 30 days of the index procedure. In multivariable analysis, prior opioid use (OR, 2.6; 95% CI, 1.6–4.2; p < 0.001), ostomy creation (OR, 2.1; 95% CI,1.2–3.7; p = 0.01), higher quantity of opioid prescription at discharge (OR, 1.9; 95% CI,1.1–3.3; p = 0.03), higher ASA classification (OR, 1.7; 95% CI, 1.1–2.6; p = 0.02), and hospital readmission (OR, 2.0; 95% CI, 1.2–3.4; p = 0.01) were independent predictors of prolonged opioid use. LIMITATIONS: This study is a retrospective review, and all variables related to prolonged opioid use are not collected in the data. CONCLUSIONS: A significant proportion of patients undergoing colectomy become prolonged opioid users. We have identified risk factors for prolonged postoperative opioid use, which may allow for improved patient education and targets for intervention preoperatively, as well as implementation of programs for monitoring and cessation of opioid use in the postoperative period. See Video Abstract at http://links.lww.com/DCR/A973. PREDICTORES DEL USO PROLONGADO DE OPIOIDES DESPUÉS DE LA COLECTOMÍA ANTECEDENTES: Los Estados Unidos se encuentran en medio de una epidemia de opioides. La cirugía gastrointestinal ha sido clasificada entre las tres subespecialidades quirúrgicas principales para la prescripción más alta de opioides. OBJETIVO: El objetivo de este estudio es determinar la tasa y los factores de riesgo para el uso prolongado de opioides después de la colectomía. DISEÑO: Este estudio utilizó datos (2015–2017) del Programa Nacional de Mejoramiento de la Calidad Quirúrgica del Colegio Americano de Cirujanos de cinco instituciones. MARCO: Dos hospitales académicos y tres comunitarios. PACIENTES: 1,243 pacientes sometidos a una colectomía. MEDIDAS DE RESULTADO PRINCIPALES: El resultado primario fue la tasa de uso prolongado de opioides, definida como una nueva receta de opioides entre 90 y 180 días después de la operación. RESULTADOS: Un total de 132 (10.6%) pacientes fueron usuarios de opioides por tiempo prolongado. En el análisis univariado, los pacientes que eran usuarios prolongados de opioides tenían una probabilidad significativamente mayor de haber tenido más de una receta de opioides en el año anterior, tenían una clasificación más alta de la Asociación Americana de Anestesiólogos, se sometieron a un procedimiento abierto, se les creó una ostomía y se les dio de alta con una cantidad grande de opioides (todos p < 0.05). Los usuarios de opioides prolongados fueron significativamente más propensos a tener una complicación (p = 0.007) o readmisión (p = 0.003) dentro de los 30 días del procedimiento índice. En el análisis multivariado, el uso previo de opioides (OR, 2.6; IC 95%, 1.6–4.2; p < 0.001), creación de ostomía (OR, 2.1; IC 95%, 1.2–3.7; p = 0.01), mayor cantidad de prescripción de opioides al dar de alta (OR, 1.9; IC 95%, 1.1–3.3; p = 0.03), clasificación más alta de la Asociación Americana de Anestesiólogos (OR, 1.7; IC 95%, 1.1–2.6; p = 0.02) y reingreso hospitalario (OR, 2.0; IC del 95%, 1.2–3.4, p = 0.01) fueron predictores independientes del uso prolongado de opioides. LIMITACIONES: Este estudio es una revisión retrospectiva y todos los variables relacionadas con el uso prolongado de opioides no se colectaron en los datos. CONCLUSIONES: Una proporción significativa de pacientes con colectomía se convierten en usuarios prolongados de opioides. Hemos identificado factores de riesgo para el uso prolongado de opioides postoperatorios, que pueden permitir una mejor educación del paciente y objetivos para la intervención preoperatoria, así como la implementación de programas para la supervisión y cese del uso de opioides en el período postoperatorio. Vea el Video de Resumen en http://links.lww.com/DCR/A973

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Adaptive mesh refinement (AMR) numerical methods utilizing octree data structures are an important class of HPC applications, in particular the solution of partial differential equations. Much effort goes into the implementation of efficient versions of these types of programs, where the emphasis is often on increasing multi-node performance when utilizing GPUs and coprocessors. By contrast, our analysis aims to characterize these workloads on traditional CPUs, as we believe that singlethreaded intra-node performance of critical kernels is still a key factor for achieving performance at scale. Especially irregular workloads such as AMR methods, however, exhibit severe underutilization on general purpose processors.In this paper, we analyze the single core performance of two state-of-the-art, highly scalable adaptive mesh refinement codes, one based on the Fast Multipole Method (FMM) and one based on the Finite Element Method (FEM), when running on a x86 CPU. We examined both scalar and vectorized implementations to identify performance bottlenecks. We demonstrate that vectorization can provide a significant benefit in achieving high performance. The greatest bottleneck to peak performance is the high fraction of non-floating point instructions in the kernels. Keywords-HPC, PVFMM, MANGLL, irregular tree, PAPI, SIMD, AVX , adaptive mesh refinement, Fast Multipole Method, Finite Element Method A comprehensive performance analysis of the two octree codes for different parameter settings.  An analysis of the benefits of vectorization and programmer inserted prefetching.  A careful evaluation of performance bottlenecks for this class of applications, including reasons for stalls and deviation from peak performance.The rest of the paper is organized as follows: Section II briefly describes the core algorithms of PVFMM and MANGLL, with an emphasis on showing how irregular tree