Anesthetic Induction Overdose Among Elderly Surgical Patients

老年手术患者麻醉诱导过量

基本信息

批准号：
10376806
负责人：
ROBERT SCHONBERGER
金额：
$ 42.9万
依托单位：
YALE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-04-01 至 2024-01-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10376806
关键词：
Acute Acute Renal Failure with Renal Papillary Necrosis Adherence Affect Age American Anesthesia procedures Anesthesiology Anesthetics Attention Blood Pressure Cardiac Caring Characteristics Clinical Clinical Data Complication Consultations Data Databases Dose Elderly Failure Feedback Future Health Care Costs Healthcare Hemorrhage Hospital Costs Hospital Mortality Hypotension Hypotensives Individual Injury to Kidney Inpatients Institution Intervention Leadership Liquid substance Measures Medicare Medicare claim Morbidity - disease rate Myocardial Infarction Operative Surgical Procedures Outcome Overdose Patients Pattern Perioperative Perioperative complication Persons Polypharmacy Population Postoperative Period Prevalence Preventive measure Professional Organizations Provider Public Health Recommendation Records Risk Safety Sampling Site Surgical incisions System Testing Work aging population base comorbidity data registry demographics design feasibility testing frailty health care service utilization high risk human old age (65+)improved member mortality older patient patient population patient subsets pressure primary outcome secondary outcome surgery outcome tool

项目摘要

1 Patients age≥65 account for nearly 40% of annual surgeries, and this proportion will increase as 2 the population ages. These older patients have more perioperative complications - e.g. acute 3 kidney injury (AKI) and myocardial infarction (MI) - and the complication rate increases by 2-4 4 fold after age 80. Anesthesia induction requirements are known to decrease significantly with 5 age. We believe perioperative complications in older surgical patients result in part from 6 a failure among anesthesiologists to follow FDA guidance to reduce induction anesthetic 7 doses for these patients – a population with polypharmacy, frailty, decreased functional 8 reserve, and multiple interacting comorbidities. Severe hypotension (mean arterial 9 pressure<55mmHg) during surgery - even for a few brief minutes - increases risk of AKI by 10 18%, and MI by 30%, highlighting the importance of preventive measures to reduce hypotensive 11 episodes. Our multi-center pilot data indicates that anesthetic induction dose substantially 12 exceeds FDA guidance for many patients age ≥65 and that high induction doses often provoke 13 hypotension among these elderly patients. Hypotension during surgery can have multiple 14 causes, but when provoked by induction anesthetic overdose, it is modifiable. We propose to 15 combine data from the Multicenter Perioperative Outcomes Group (MPOG) database – 16 containing over 9.3 million anesthetic records from 44 centers - with Medicare data to, 1) identify 17 the prevalence of deviation from FDA induction dosing guidance nationwide; 2) test the 18 contribution of anesthetic induction overdose to perioperative complications; and 3) feasibility 19 test a pilot, quality improvement (QI) tool concerning deviation from FDA guidance on induction 20 dosing for the elderly. Among patients age≥65, and separately among those age≥80, our aims 21 are: Aim 1: To measure provider variability and identify outliers in FDA-adherent anesthetic 22 induction practice; Aim 2: Measure the association of anesthetic induction overdose to, a) 23 clinically meaningful hypotension, and b) subsequent postoperative morbidity and mortality; and 24 Aim 3: Develop and feasibility test a QI feedback tool – leveraging an established MPOG 25 platform - focused on deviation from FDA guidance for induction dosing of the elderly. 26 Public Health Significance: Demonstrating patterns of anesthetic overdose in excess of FDA 27 guidance and the consequences of this care failure among vulnerable subsets of patients, we 28 will highlight a clear target – FDA-adherent age-adjustment of anesthesia induction dose - to 29 make healthcare safer for older patients. The proposed analyses will support the testing of an 30 intervention to increase FDA-adherent anesthesia induction dosing for older Americans.

1名患者≥65岁占年度手术的近40％，这一比例将增加 2人口年龄。这些老年患者有更多的周期并发症 - 例如急性 3肾损伤（AKI）和心肌梗塞（MI），并发症率增加2-4 40岁以后的4倍。已知麻醉诱导要求会显着降低 5岁。我们认为，老年手术患者的周期性并发症部分导致 6麻醉师之间未能遵循FDA指导以减少诱导麻醉这些患者的7剂 - 多药，脆弱，功能改善的人群 8储备金和多种互动合并症。严重的低血压（平均动脉 9压力<55mmhg）在手术过程中 - 即使短短几分钟 - 也会增加AKI的风险 10 18％，MI降低30％，强调了预防措施减少低血压的重要性 11集。我们的多中心飞行员数据表明麻醉诱导剂量基本上是 12超过FDA的指导，对于许多年龄≥65岁的患者，高诱导剂量经常引起 13这些老年患者的低血压。手术期间的低血压可以有多个 14原因，但是当通过诱导麻醉过量引起时，它是可修改的。我们建议 15结合来自多中心围手术期结果组（MPOG）数据库的数据 - 16包含来自44个中心的930万个麻醉记录 - 带有Medicare数据到1）确定 17全国范围内FDA归纳剂量指南的流行率； 2）测试 18麻醉诱导过量对周期并发症的贡献； 3）可行性 19测试飞行员，质量改进（QI）工具，涉及脱离FDA归纳指南 20剂量的剂量。在年龄≥65岁的患者中，在年龄≥80岁的患者中，我们的目标 21是：目标1：测量提供商的可变性并识别FDA粘附麻醉中的异常值 22归纳练习；目标2：测量麻醉诱导过量与a的关联，a） 23临床上有意义的低血压，b）随后的术后发病率和死亡率；和 24 AIM 3：开发和可行性测试Qi反馈工具 - 利用已建立的MPOG 25平台 - 专注于远离FDA的归纳剂量指南。 26公共卫生的意义：证明超过FDA的麻醉过量的模式 27指导和这种护理失败在脆弱的患者子集中的后果，我们 28将突出一个明确的目标 - 对麻醉剂量的FDA辅助年龄调整 - 29使老年患者更安全。提出的分析将支持测试 30干预措施以增加对年长美国人的FDA粘附麻醉剂量。