Practice Patterns and Variability in Intraoperative Opioid Utilization: A Report From the Multicenter Perioperative Outcomes Group
Practice Patterns and Variability in Intraoperative Opioid Utilization: A Report From the Multicenter Perioperative Outcomes Group
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DOI：
10.1213/ane.0000000000005663
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发表时间：
2022-01-01
影响因子：
5.7
通讯作者：
Pace, Nathan L.
中科院分区：
文献类型：
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作者：
Naik, Bhiken, I;Kuck, Kai;Pace, Nathan L.
背景：阿片类药物仍然是术中镇痛的主要方式。关于患者、程序和机构特征如何影响术中阿片类药物给药的数据有限。这项从2012年到2016年的回顾性纵向研究的目的是评估术中阿片类药物剂量如何随患者和临床护理因素以及多个机构在一段时间内的变化而变化。方法：从10家机构收集了人口统计学、手术程序、麻醉技术和术中止痛数据作为术中阿片类药物使用的假设变量。采用多元线性回归模型，将静脉注射吗啡当量(PME)作为15个协变量的函数：3个连续协变量(年龄、麻醉时间、年份)和12个因素协变量(外周阻滞、神经轴阻滞、全身麻醉、急诊状态、种族、性别、瑞芬太尼输注、大手术、美国麻醉学家协会[ASA]身体状况、非阿片类止痛药计数、多中心围术期结局组[MPOG]机构、手术类别)。模型中包含了一个交互作用(按MPOG机构计算的年份)。回归模型同时对所有纳入变量进行了调整。因素内水平的比较报告为95%可信区间(CRI)的中位数比率。结果：2012年1月至2016年12月共分析了1,104,324例。研究期间每例PME的中位数(四分位数范围)和按体重标化的PME分别为15(10-28)mg和200(111-347)微克/公斤。根据多变量模型的估计，阿片类药物的使用持续减少(平均95%CRI)，从2012年的152(151-153)微克/公斤下降到2016年的129(129-130)微克/公斤。PME受制度影响的变异率为25.6%(24.8%~26.5%)。男性开出的阿片类药物(130[129-130]微克/公斤)少于女性(144[143-145]微克/公斤)。男女PME之比为0.90(0.89~0.90)。不同机构间的PME给药有很大的差异，最低为80(79-81)微克/公斤，最高为186(184-187)微克/公斤；PME比率为0.43(0.42-0.43)。结论：我们观察到术中阿片类药物的应用随着时间的推移而减少，不同性别和不同手术类型的剂量差异不同。此外，即使在对多个变量进行调整时，各机构之间的阿片类药物使用也存在很大差异。
BACKGROUND: Opioids remain the primary mode of analgesia intraoperatively. There are limited data on how patient, procedural, and institutional characteristics influence intraoperative opioid administration. The aim of this retrospective, longitudinal study from 2012 to 2016 was to assess how intraoperative opioid dosing varies by patient and clinical care factors and across multiple institutions over time.METHODS: Demographic, surgical procedural, anesthetic technique, and intraoperative analgesia data as putative variables of intraoperative opioid utilization were collected from 10 institutions. Log parenteral morphine equivalents (PME) was modeled in a multivariable linear regression model as a function of 15 covariates: 3 continuous covariates (age, anesthesia duration, year) and 12 factor covariates (peripheral block, neuraxial block, general anesthesia, emergency status, race, sex, remifentanil infusion, major surgery, American Society of Anesthesiologists [ASA] physical status, non-opioid analgesic count, Multicenter Perioperative Outcomes Group [MPOG] institution, surgery category). One interaction (year by MPOG institution) was included in the model. The regression model adjusted simultaneously for all included variables. Comparison of levels within a factor were reported as a ratio of medians with 95% credible intervals (CrI).RESULTS: A total of 1,104,324 cases between January 2012 and December 2016 were analyzed. The median (interquartile range) PME and standardized by weight PME per case for the study period were 15 (10-28) mg and 200 (111-347) mu g/kg, respectively. As estimated in the multivariable model, there was a sustained decrease in opioid use (mean, 95% CrI) dropping from 152 (151-153) mu g/kg in 2012 to 129 (129-130) mu g/kg in 2016. The percent of variability in PME due to institution was 25.6% (24.8%-26.5%). Less opioids were prescribed in men (130 [129-130] mu g/kg) than women (144 [143-145] mu g/kg). The men to women PME ratio was 0.90 (0.89-0.90). There was substantial variability in PME administration among institutions, with the lowest being 80 (79-81) mu g/kg and the highest being 186 (184-187) mu g/kg; this is a PME ratio of 0.43 (0.42-0.43).CONCLUSIONS: We observed a reduction in intraoperative opioid administration over time, with variability in dose ranging between sexes and by procedure type. Furthermore, there was substantial variability in opioid use between institutions even when adjusting for multiple variables.